- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.64 / $1,375.64 / $1,375.64
| Facility | | $1,375.64 | $1,375.64 | $1,375.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $155.86 / $276.75
| Professional | | $85.00 | $155.86 | $276.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.55 / $124.17 / $184.56
| Professional | | $105.55 | $124.17 | $184.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.50 / $203.80 / $369.00
| Professional | | $144.50 | $203.80 | $369.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.89 / $209.24 / $343.14
| Professional | | $117.89 | $209.24 | $343.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.64 / $1,375.64 / $1,375.64
| Facility | | $1,375.64 | $1,375.64 | $1,375.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.08 / $154.94 / $311.89
| Professional | | $92.08 | $154.94 | $311.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.96 / $234.84 / $318.35
| Professional | | $161.96 | $234.84 | $318.35 |