- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.84 / $45.48 / $167.63
| Professional | | $24.84 | $45.48 | $167.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.06 / $443.71 / $464.35
| Facility | | $202.06 | $443.71 | $464.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $48.76 / $110.29
| Professional | | $18.00 | $48.76 | $110.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.92 / $48.76 / $110.29
| Professional | | $20.92 | $48.76 | $110.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $36.42 / $60.23
| Professional | | $11.39 | $36.42 | $60.23 |