- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.27 / $418.25 / $599.79
| Professional | | $42.27 | $418.25 | $599.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.48 / $317.05 / $384.48
| Facility | | $126.48 | $317.05 | $384.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.44 / $112.44 / $112.44
| Professional | | $112.44 | $112.44 | $112.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.11 / $113.00 / $599.79
| Facility | | $47.11 | $113.00 | $599.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.90 / $48.07 / $68.12
| Professional | | $37.90 | $48.07 | $68.12 |