- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.86 / $679.07 / $742.45
| Facility | | $239.86 | $679.07 | $742.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.45 / $239.86 / $239.86
| Professional | | $228.45 | $239.86 | $239.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.16 / $372.92 / $726.69
| Facility | | $235.16 | $372.92 | $726.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.45 / $228.45 / $228.45
| Professional | | $228.45 | $228.45 | $228.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.38 / $263.38 / $263.38
| Facility | | $263.38 | $263.38 | $263.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.38 / $263.38 / $263.38
| Professional | | $263.38 | $263.38 | $263.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.98 / $253.98 / $253.98
| Facility | | $253.98 | $253.98 | $253.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.98 / $282.20 / $282.20
| Professional | | $253.98 | $282.20 | $282.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.16 / $253.97 / $259.61
| Professional | | $235.16 | $253.97 | $259.61 |