- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.64 / $85.82 / $452.59
| Facility | | $33.64 | $85.82 | $452.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.40 / $148.81 / $171.95
| Professional | | $114.40 | $148.81 | $171.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.68 / $267.68 / $470.56
| Facility | | $267.68 | $267.68 | $470.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.45 / $203.88 / $277.06
| Professional | | $126.45 | $203.88 | $277.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.24 / $186.44 / $234.45
| Professional | | $142.24 | $186.44 | $234.45 |