- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.27 / $291.27 / $291.27
| Facility | | $291.27 | $291.27 | $291.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.87 / $291.27 / $313.14
| Professional | | $171.87 | $291.27 | $313.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.38 / $281.38 / $281.38
| Professional | | $281.38 | $281.38 | $281.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.88 / $232.88 / $232.88
| Professional | | $232.88 | $232.88 | $232.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.87 / $285.45 / $335.83
| Professional | | $251.87 | $285.45 | $335.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.19 / $291.27 / $331.94
| Facility | | $214.19 | $291.27 | $331.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.36 / $261.36 / $261.36
| Professional | | $261.36 | $261.36 | $261.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.22 / $280.29 / $336.35
| Facility | | $210.22 | $280.29 | $336.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.22 / $280.29 / $336.35
| Professional | | $210.22 | $280.29 | $336.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.32 / $304.89 / $566.83
| Professional | | $186.32 | $304.89 | $566.83 |