- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.71 / $76.75 / $102.79
| Professional | | $59.71 | $76.75 | $102.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.48 / $104.48 / $104.48
| Professional | | $104.48 | $104.48 | $104.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.62 / $81.62 / $109.27
| Facility | | $81.62 | $81.62 | $109.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.38 / $81.62 / $109.27
| Professional | | $69.38 | $81.62 | $109.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.62 / $81.62 / $109.27
| Facility | | $81.62 | $81.62 | $109.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.62 / $81.62 / $109.27
| Professional | | $81.62 | $81.62 | $109.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $110.16 / $159.16
| Professional | | $42.66 | $110.16 | $159.16 |