- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.52 / $61.52 / $158.18
| Facility | | $61.52 | $61.52 | $158.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.52 / $61.52 / $82.61
| Professional | | $61.52 | $61.52 | $82.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.10 / $177.08 / $198.72
| Professional | | $146.10 | $177.08 | $198.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.19 / $102.20 / $128.51
| Professional | | $101.19 | $102.20 | $128.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.52 / $104.58 / $417.43
| Facility | | $61.52 | $104.58 | $417.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.90 / $89.99 / $149.40
| Professional | | $36.90 | $89.99 | $149.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.90 / $45.06 / $127.43
| Professional | | $36.90 | $45.06 | $127.43 |