- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.83 / $54.02 / $61.44
| Professional | | $29.83 | $54.02 | $61.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.47 / $197.81 / $234.19
| Facility | | $146.47 | $197.81 | $234.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.51 / $67.66 / $93.68
| Professional | | $57.51 | $67.66 | $93.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.94 / $58.00 / $59.91
| Facility | | $56.94 | $58.00 | $59.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.34 / $56.94 / $58.00
| Professional | | $42.34 | $56.94 | $58.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.03 / $52.35 / $86.14
| Professional | | $38.03 | $52.35 | $86.14 |