- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.16 / $246.82 / $246.82
| Professional | | $71.16 | $246.82 | $246.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.15 / $67.36 / $67.36
| Facility | | $48.15 | $67.36 | $67.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.15 / $54.78 / $67.36
| Professional | | $48.15 | $54.78 | $67.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.77 / $64.15 / $67.36
| Facility | | $35.77 | $64.15 | $67.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.15 / $50.56 / $70.23
| Professional | | $48.15 | $50.56 | $70.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.93 / $32.00 / $50.77
| Professional | | $28.93 | $32.00 | $50.77 |