- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.68 / $295.68 / $318.63
| Facility | | $295.68 | $295.68 | $318.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $132.55 / $152.75
| Professional | | $127.45 | $132.55 | $152.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.33 / $154.81 / $403.89
| Facility | | $123.33 | $154.81 | $403.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $127.45
| Professional | | $127.45 | $127.45 | $127.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $127.45
| Facility | | $127.45 | $127.45 | $127.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $127.45
| Professional | | $127.45 | $127.45 | $127.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $154.34
| Professional | | $127.45 | $127.45 | $154.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.68 / $295.68 / $318.63
| Facility | | $295.68 | $295.68 | $318.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $152.75 / $318.63
| Professional | | $127.45 | $152.75 | $318.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $215.54
| Professional | | $127.45 | $127.45 | $215.54 |