- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.52 / $182.52 / $285.18
| Facility | | $182.52 | $182.52 | $285.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.33 / $272.79 / $353.85
| Professional | | $171.33 | $272.79 | $353.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.27 / $244.27 / $244.27
| Professional | | $244.27 | $244.27 | $244.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.38 / $252.38 / $252.38
| Facility | | $252.38 | $252.38 | $252.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.38 / $252.38 / $252.38
| Professional | | $252.38 | $252.38 | $252.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.51 / $203.51 / $203.51
| Facility | | $203.51 | $203.51 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.56 / $148.56 / $203.51
| Professional | | $148.56 | $148.56 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.32 / $162.47 / $250.38
| Professional | | $108.32 | $162.47 | $250.38 |