- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.05 / $129.05 / $134.99
| Professional | | $129.05 | $129.05 | $134.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.49 / $276.91 / $331.95
| Professional | | $253.49 | $276.91 | $331.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.36 / $308.77 / $398.74
| Professional | | $159.36 | $308.77 | $398.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.25 / $246.62 / $334.54
| Professional | | $134.25 | $246.62 | $334.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.25 / $262.68 / $334.54
| Professional | | $134.25 | $262.68 | $334.54 |