- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.59 / $212.81 / $456.63
| Facility | | $206.59 | $212.81 | $456.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.59 / $208.65 / $250.01
| Professional | | $206.59 | $208.65 | $250.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.03 / $169.58 / $203.84
| Facility | | $106.03 | $169.58 | $203.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.84 / $203.84 / $207.92
| Professional | | $203.84 | $203.84 | $207.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.90 / $194.90 / $206.59
| Facility | | $194.90 | $194.90 | $206.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.59 / $206.59 / $206.59
| Professional | | $206.59 | $206.59 | $206.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.65 / $206.59 / $278.02
| Professional | | $202.65 | $206.59 | $278.02 |