- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.96 / $201.96 / $268.58
| Professional | | $130.96 | $201.96 | $268.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.44 / $302.19 / $696.93
| Professional | | $145.44 | $302.19 | $696.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $148.00 / $383.55
| Professional | | $12.00 | $148.00 | $383.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.50 / $230.67 / $394.97
| Professional | | $114.50 | $230.67 | $394.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.70 / $240.27 / $467.92
| Professional | | $127.70 | $240.27 | $467.92 |