- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.42 / $311.42 / $439.07
| Facility | | $311.42 | $311.42 | $439.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.58 / $315.27 / $326.80
| Professional | | $307.58 | $315.27 | $326.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.80 / $326.80 / $326.80
| Facility | | $326.80 | $326.80 | $326.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.80 / $326.80 / $326.80
| Professional | | $326.80 | $326.80 | $326.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.42 / $326.99 / $384.47
| Facility | | $311.42 | $326.99 | $384.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $1,460.99
| Professional | | $320.39 | $320.39 | $1,460.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $353.29
| Professional | | $320.39 | $320.39 | $353.29 |