- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.57 / $56.57 / $65.27
| Professional | | $56.57 | $56.57 | $65.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.37 / $81.37 / $85.21
| Facility | | $81.37 | $81.37 | $85.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.62 / $74.70 / $86.75
| Professional | | $58.62 | $74.70 | $86.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.37 / $81.37 / $85.21
| Facility | | $81.37 | $81.37 | $85.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.62 / $81.37 / $86.75
| Professional | | $58.62 | $81.37 | $86.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.56 / $68.67 / $134.02
| Professional | | $38.56 | $68.67 | $134.02 |