- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $231.53
| Professional | | $150.00 | $150.00 | $231.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.22 / $188.50 / $188.50
| Professional | | $160.22 | $188.50 | $188.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.98 / $183.12 / $253.46
| Professional | | $115.98 | $183.12 | $253.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.92 / $168.42 / $1,156.83
| Professional | | $124.92 | $168.42 | $1,156.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.87 / $143.66 / $263.27
| Professional | | $122.87 | $143.66 | $263.27 |