- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.16 / $55.16 / $76.25
| Professional | | $55.16 | $55.16 | $76.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.68 / $109.01 / $207.91
| Professional | | $27.68 | $109.01 | $207.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.45 / $76.25 / $157.44
| Professional | | $43.45 | $76.25 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.45 / $115.74 / $209.37
| Professional | | $96.45 | $115.74 | $209.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.16 / $68.84 / $76.25
| Professional | | $55.16 | $68.84 | $76.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.15 / $76.67 / $165.54
| Professional | | $47.15 | $76.67 | $165.54 |