- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.04 / $369.38 / $373.44
| Facility | | $209.04 | $369.38 | $373.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.04 / $369.38 / $385.47
| Professional | | $209.04 | $369.38 | $385.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $208.25 / $208.25
| Professional | | $208.25 | $208.25 | $208.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.55 / $837.55 / $837.55
| Facility | | $837.55 | $837.55 | $837.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.16 / $278.16 / $410.75
| Professional | | $278.16 | $278.16 | $410.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.28 / $346.65 / $609.70
| Professional | | $231.28 | $346.65 | $609.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.16 / $226.16 / $463.60
| Professional | | $226.16 | $226.16 | $463.60 |