- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $71.76 / $274.97
| Professional | | $29.48 | $71.76 | $274.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $340.85
| Facility | | $55.00 | $55.00 | $340.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.94 / $295.93 / $322.23
| Professional | | $150.94 | $295.93 | $322.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.57 / $58.63 / $103.26
| Facility | | $17.57 | $58.63 | $103.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.00 / $81.00 / $81.00
| Professional | | $81.00 | $81.00 | $81.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.57 / $58.63 / $103.26
| Facility | | $17.57 | $58.63 | $103.26 |