- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $52.48 / $144.54
| Professional | | $38.02 | $52.48 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $190.55 / $218.78
| Facility | | $138.04 | $190.55 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $61.66 / $102.33
| Professional | | $46.77 | $61.66 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $60.26
| Facility | | $54.95 | $54.95 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $60.26
| Professional | | $44.67 | $44.67 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $54.95 / $120.23
| Facility | | $43.65 | $54.95 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $53.70 / $79.43
| Professional | | $42.66 | $53.70 | $79.43 |