- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.46 / $541.76 / $970.80
| Facility | | $238.46 | $541.76 | $970.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $262.30
| Professional | | $238.46 | $238.46 | $262.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.64 / $173.64 / $238.46
| Professional | | $173.64 | $173.64 | $238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.96 / $224.96 / $238.46
| Facility | | $224.96 | $224.96 | $238.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.40 / $238.46 / $238.46
| Professional | | $188.40 | $238.46 | $238.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.69 / $238.46 / $1,226.06
| Professional | | $202.69 | $238.46 | $1,226.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $265.45 / $351.02
| Professional | | $238.46 | $265.45 | $351.02 |