- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.66 / $173.66 / $434.15
| Facility | | $173.66 | $173.66 | $434.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.66 / $140.66 / $173.66
| Professional | | $140.66 | $140.66 | $173.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.05 / $255.28 / $1,737.47
| Facility | | $168.05 | $255.28 | $1,737.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.45 / $69.45 / $215.02
| Professional | | $69.45 | $69.45 | $215.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.42 / $370.42 / $380.61
| Facility | | $370.42 | $370.42 | $380.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.04 / $175.79 / $351.05
| Professional | | $117.04 | $175.79 | $351.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.66 / $208.06 / $308.23
| Professional | | $173.66 | $208.06 | $308.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.66 / $173.66 / $434.15
| Facility | | $173.66 | $173.66 | $434.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.66 / $173.66 / $173.66
| Professional | | $140.66 | $173.66 | $173.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.61 / $226.57 / $396.50
| Professional | | $147.61 | $226.57 | $396.50 |