- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.35 / $316.64 / $550.70
| Facility | | $275.35 | $316.64 | $550.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.44 / $245.44 / $245.44
| Professional | | $245.44 | $245.44 | $245.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $44.39 / $59.72
| Facility | | $36.58 | $44.39 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $110.19 / $156.94
| Professional | | $95.50 | $110.19 | $156.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $223.73 / $596.00
| Facility | | $175.40 | $223.73 | $596.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.65 / $115.65 / $247.82
| Professional | | $115.65 | $115.65 | $247.82 |