- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.52 / $258.52 / $258.64
| Facility | | $258.52 | $258.52 | $258.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.63 / $258.64 / $310.37
| Professional | | $258.63 | $258.64 | $310.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.93 / $248.93 / $248.93
| Professional | | $248.93 | $248.93 | $248.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,571.97 / $12,829.58 / $17,259.89
| Facility | | $10,571.97 | $12,829.58 | $17,259.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.64 / $258.64 / $258.64
| Professional | | $258.64 | $258.64 | $258.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.64 / $258.64 / $258.64
| Facility | | $258.64 | $258.64 | $258.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.64 / $258.64 / $260.54
| Professional | | $258.64 | $258.64 | $260.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.08 / $258.64 / $281.92
| Professional | | $212.08 | $258.64 | $281.92 |