- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.65 / $56.58 / $68.75
| Professional | | $50.65 | $56.58 | $68.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.89 / $221.37 / $262.08
| Facility | | $163.89 | $221.37 | $262.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.48 / $65.27 / $104.83
| Professional | | $55.48 | $65.27 | $104.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.06 / $81.37 / $81.37
| Facility | | $67.06 | $81.37 | $81.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.40 / $81.37 / $81.37
| Professional | | $59.40 | $81.37 | $81.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.84 / $57.83 / $96.39
| Professional | | $39.84 | $57.83 | $96.39 |