- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.70 / $474.70 / $511.53
| Facility | | $474.70 | $474.70 | $511.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.61 / $212.80 / $248.39
| Professional | | $204.61 | $212.80 | $248.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.00 / $248.54 / $648.41
| Facility | | $198.00 | $248.54 | $648.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.61 / $204.61 / $204.61
| Professional | | $204.61 | $204.61 | $204.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.06 / $204.61 / $370.01
| Facility | | $200.06 | $204.61 | $370.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.61 / $204.61 / $204.61
| Professional | | $204.61 | $204.61 | $204.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.36 / $195.36 / $236.58
| Professional | | $195.36 | $195.36 | $236.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.70 / $474.70 / $511.53
| Facility | | $474.70 | $474.70 | $511.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.61 / $212.87 / $344.87
| Professional | | $204.61 | $212.87 | $344.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.92 / $204.61 / $296.68
| Professional | | $173.92 | $204.61 | $296.68 |