- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.68 / $49.68 / $567.13
| Professional | | $49.68 | $49.68 | $567.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.62 / $147.62 / $147.62
| Facility | | $147.62 | $147.62 | $147.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.85 / $197.85 / $197.85
| Professional | | $197.85 | $197.85 | $197.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.62 / $147.62 / $147.62
| Facility | | $147.62 | $147.62 | $147.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $197.85
| Professional | | $55.00 | $55.00 | $197.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.53 / $88.20 / $203.78
| Professional | | $38.53 | $88.20 | $203.78 |