- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.28 / $204.06 / $309.12
| Facility | | $50.28 | $204.06 | $309.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.96 / $73.06 / $106.59
| Professional | | $43.96 | $73.06 | $106.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.93 / $81.98 / $154.50
| Professional | | $57.93 | $81.98 | $154.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.66 / $207.66 / $207.66
| Facility | | $207.66 | $207.66 | $207.66 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $395.44 / $395.44 / $395.44
| Facility | 50 | $395.44 | $395.44 | $395.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.67 / $68.67 / $68.67
| Professional | | $68.67 | $68.67 | $68.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.95 / $141.66 / $183.23
| Professional | | $79.95 | $141.66 | $183.23 |