- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $281.84 / $363.08
| Facility | | $239.88 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $407.38
| Professional | | $30.20 | $45.71 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $295.12 / $346.74
| Professional | | $257.04 | $295.12 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $239.88 / $309.03
| Professional | | $134.90 | $239.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $66.07 / $97.72
| Professional | | $50.12 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $97.72
| Professional | | $50.12 | $70.79 | $97.72 |