- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.25 / $431.54 / $750.50
| Facility | | $375.25 | $431.54 | $750.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.70 / $431.54 / $431.54
| Professional | | $292.70 | $431.54 | $431.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.89 / $70.31 / $243.48
| Professional | | $57.89 | $70.31 | $243.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.03 / $304.89 / $1,176.83
| Facility | | $239.03 | $304.89 | $1,176.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.63 / $166.93 / $395.37
| Professional | | $155.63 | $166.93 | $395.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $157.61 / $225.15
| Professional | | $157.61 | $157.61 | $225.15 |