- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.52 / $691.52 / $745.18
| Facility | | $691.52 | $691.52 | $745.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.42 / $253.36 / $253.36
| Professional | | $244.42 | $253.36 | $253.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.54 / $284.42 / $810.76
| Facility | | $227.54 | $284.42 | $810.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.39 / $253.35 / $253.36
| Professional | | $248.39 | $253.35 | $253.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.21 / $253.36 / $253.36
| Facility | | $241.21 | $253.36 | $253.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.36 / $253.36 / $253.36
| Professional | | $253.36 | $253.36 | $253.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.36 / $253.36 / $253.36
| Professional | | $253.36 | $253.36 | $253.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.52 / $691.52 / $745.18
| Facility | | $691.52 | $691.52 | $745.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.40 / $253.36 / $253.36
| Professional | | $247.40 | $253.36 | $253.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.39 / $248.39 / $360.17
| Professional | | $248.39 | $248.39 | $360.17 |