- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.27 / $268.27 / $268.27
| Facility | | $268.27 | $268.27 | $268.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.96 / $241.52 / $268.27
| Professional | | $230.96 | $241.52 | $268.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.43 / $376.14 / $382.65
| Professional | | $321.43 | $376.14 | $382.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.25 / $329.51 / $414.34
| Professional | | $326.25 | $329.51 | $414.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.21 / $268.27 / $1,288.56
| Facility | | $41.21 | $268.27 | $1,288.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $140.13 / $249.70
| Professional | | $12.25 | $140.13 | $249.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.40 / $140.13 / $264.92
| Professional | | $11.40 | $140.13 | $264.92 |