- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.53 / $257.45 / $1,150.80
| Facility | | $208.53 | $257.45 | $1,150.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.53 / $208.53 / $257.45
| Professional | | $208.53 | $208.53 | $257.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.13 / $378.45 / $895.71
| Facility | | $249.13 | $378.45 | $895.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.98 / $102.98 / $167.34
| Professional | | $102.98 | $102.98 | $167.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.28 / $188.28 / $549.13
| Facility | | $188.28 | $188.28 | $549.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.28 / $260.57 / $438.83
| Professional | | $181.28 | $260.57 | $438.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.45 / $257.45 / $260.02
| Professional | | $257.45 | $257.45 | $260.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $335.07 / $3,348.12
| Facility | | $257.45 | $335.07 | $3,348.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.53 / $257.45 / $257.45
| Professional | | $208.53 | $257.45 | $257.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.23 / $154.47 / $196.12
| Professional | | $67.23 | $154.47 | $196.12 |