- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $391.26
| Facility | | $230.15 | $230.15 | $391.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $232.46
| Professional | | $230.15 | $230.15 | $232.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.56 / $271.41 / $460.30
| Facility | | $260.56 | $271.41 | $460.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.62 / $230.15 / $230.15
| Professional | | $195.62 | $230.15 | $230.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $250.27 / $368.24
| Facility | | $230.15 | $250.27 | $368.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $253.17 / $354.43
| Professional | | $230.15 | $253.17 | $354.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.07 / $230.15 / $230.15
| Facility | | $228.07 | $230.15 | $230.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.75 / $230.15 / $420.62
| Professional | | $183.75 | $230.15 | $420.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $230.15
| Professional | | $230.15 | $230.15 | $230.15 |