- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $63.10 / $208.93
| Professional | | $44.67 | $63.10 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $239.88
| Facility | | $151.36 | $204.17 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $54.95 / $109.65
| Professional | | $40.74 | $54.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $63.10
| Facility | | $54.95 | $54.95 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $58.88 / $87.10
| Professional | | $43.65 | $58.88 | $87.10 |