- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $320.98 / $356.06
| Facility | | $175.40 | $320.98 | $356.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.57 / $320.98 / $356.06
| Professional | | $138.57 | $320.98 | $356.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.71 / $201.71 / $201.71
| Facility | | $201.71 | $201.71 | $201.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.01 / $114.01 / $119.71
| Facility | | $114.01 | $114.01 | $119.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.01 / $140.28 / $304.70
| Professional | | $76.01 | $140.28 | $304.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.86 / $157.86 / $175.40
| Facility | | $157.86 | $157.86 | $175.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.67 / $105.24 / $263.10
| Professional | | $73.67 | $105.24 | $263.10 |