- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.05 / $284.79 / $750.91
| Facility | | $237.05 | $284.79 | $750.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.50 / $232.50 / $249.75
| Professional | | $187.50 | $232.50 | $249.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.74 / $241.74 / $241.74
| Professional | | $241.74 | $241.74 | $241.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.58 / $265.58 / $265.58
| Professional | | $265.58 | $265.58 | $265.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.96 / $255.96 / $255.96
| Professional | | $255.96 | $255.96 | $255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.40 / $267.95 / $284.39
| Professional | | $228.40 | $267.95 | $284.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.80 / $237.80 / $237.80
| Professional | | $237.80 | $237.80 | $237.80 |