- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $67.15 / $77.48
| Professional | | $67.15 | $67.15 | $77.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.52 / $64.52 / $101.15
| Facility | | $64.52 | $64.52 | $101.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.10 / $64.52 / $68.78
| Professional | | $47.10 | $64.52 | $68.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.52 / $64.52 / $101.15
| Facility | | $64.52 | $64.52 | $101.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.10 / $64.52 / $68.78
| Professional | | $47.10 | $64.52 | $68.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.77 / $81.52 / $159.08
| Professional | | $45.77 | $81.52 | $159.08 |