- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.95 / $69.67 / $74.47
| Professional | | $68.95 | $69.67 | $74.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.88 / $37.88 / $37.88
| Professional | | $37.88 | $37.88 | $37.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.46 / $73.20 / $102.28
| Facility | | $47.46 | $73.20 | $102.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.88 / $73.95 / $10,000.00
| Professional | | $37.88 | $73.95 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.59 / $39.36 / $56.49
| Professional | | $35.59 | $39.36 | $56.49 |