- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.27 / $275.45 / $275.45
| Professional | | $49.27 | $275.45 | $275.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.12 / $72.83 / $244.19
| Facility | | $62.12 | $72.83 | $244.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.43 / $62.12 / $62.12
| Professional | | $29.43 | $62.12 | $62.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.12 / $72.83 / $244.19
| Facility | | $62.12 | $72.83 | $244.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.56 / $38.56 / $62.12
| Professional | | $38.56 | $38.56 | $62.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $17.98 / $42.84
| Professional | | $17.98 | $17.98 | $42.84 |