- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.99 / $105.38 / $162.44
| Facility | | $92.99 | $105.38 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.45 / $110.98 / $141.84
| Professional | | $93.45 | $110.98 | $141.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.71 / $129.51 / $246.83
| Professional | | $96.71 | $129.51 | $246.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.95 / $179.95 / $371.42
| Facility | | $179.95 | $179.95 | $371.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.71 / $135.01 / $191.06
| Professional | | $101.71 | $135.01 | $191.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.85 / $214.46 / $214.46
| Professional | | $141.85 | $214.46 | $214.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.21 / $137.26 / $228.61
| Professional | | $99.21 | $137.26 | $228.61 |