- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.45 / $227.70 / $232.51
| Facility | | $203.45 | $227.70 | $232.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.76 / $203.45 / $261.57
| Professional | | $193.76 | $203.45 | $261.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.18 / $158.18 / $158.18
| Facility | | $158.18 | $158.18 | $158.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.76 / $193.76 / $223.57
| Facility | | $193.76 | $193.76 | $223.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.76 / $193.76 / $193.76
| Professional | | $193.76 | $193.76 | $193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.01 / $193.76 / $251.89
| Professional | | $186.01 | $193.76 | $251.89 |