- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.35 / $149.99 / $176.46
| Facility | | $132.35 | $149.99 | $176.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.13 / $133.33 / $191.21
| Professional | | $106.13 | $133.33 | $191.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.56 / $199.91 / $228.14
| Professional | | $147.56 | $199.91 | $228.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $206.72 / $289.36
| Professional | | $104.00 | $206.72 | $289.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.50 / $147.61 / $203.23
| Professional | | $104.50 | $147.61 | $203.23 |