- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.81 / $93.55 / $471.77
| Professional | | $52.81 | $93.55 | $471.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.80 / $122.80 / $122.80
| Facility | | $122.80 | $122.80 | $122.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.01 / $85.62 / $164.61
| Professional | | $36.01 | $85.62 | $164.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.80 / $122.80 / $122.80
| Facility | | $122.80 | $122.80 | $122.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.01 / $85.62 / $164.61
| Professional | | $36.01 | $85.62 | $164.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.04 / $75.44 / $169.51
| Professional | | $32.04 | $75.44 | $169.51 |