- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.74 / $272.60 / $368.01
| Facility | | $198.74 | $272.60 | $368.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.68 / $117.68 / $117.68
| Professional | | $117.68 | $117.68 | $117.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.44 / $223.44 / $223.44
| Facility | | $223.44 | $223.44 | $223.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.92 / $246.92 / $246.92
| Professional | | $246.92 | $246.92 | $246.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.82 / $101.66 / $112.99
| Facility | | $96.82 | $101.66 | $112.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.56 / $89.38 / $273.52
| Professional | | $62.56 | $89.38 | $273.52 |