- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.34 / $211.34 / $211.34
| Facility | | $211.34 | $211.34 | $211.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.34 / $211.34 / $353.70
| Professional | | $211.34 | $211.34 | $353.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.13 / $192.03 / $237.66
| Professional | | $190.13 | $192.03 | $237.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.49 / $302.22 / $579.07
| Facility | | $198.49 | $302.22 | $579.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.05 / $228.05 / $228.05
| Professional | | $228.05 | $228.05 | $228.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.83 / $215.83 / $215.83
| Professional | | $215.83 | $215.83 | $215.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.34 / $211.34 / $211.34
| Professional | | $211.34 | $211.34 | $211.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.05 / $228.05 / $234.27
| Professional | | $228.05 | $228.05 | $234.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.32 / $207.32 / $207.32
| Facility | | $207.32 | $207.32 | $207.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.32 / $207.32 / $207.32
| Professional | | $207.32 | $207.32 | $207.32 |