- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $324.58 / $811.45
| Facility | | $324.58 | $324.58 | $811.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.91 / $262.91 / $324.58
| Professional | | $262.91 | $262.91 | $324.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.10 / $477.13 / $2,322.30
| Facility | | $314.10 | $477.13 | $2,322.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.83 / $129.83 / $308.35
| Professional | | $129.83 | $129.83 | $308.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.33 / $692.33 / $692.33
| Facility | | $692.33 | $692.33 | $692.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.51 / $328.33 / $402.67
| Professional | | $205.51 | $328.33 | $402.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.58 / $324.58 / $327.83
| Professional | | $324.58 | $324.58 | $327.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $324.58 / $811.45
| Facility | | $324.58 | $324.58 | $811.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.91 / $324.58 / $324.58
| Professional | | $262.91 | $324.58 | $324.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.75 / $194.75 / $486.87
| Professional | | $194.75 | $194.75 | $486.87 |