- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.50 / $298.20 / $305.77
| Facility | | $248.50 | $298.20 | $305.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.50 / $248.50 / $258.44
| Professional | | $248.50 | $248.50 | $258.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.08 / $447.30 / $1,086.11
| Facility | | $297.08 | $447.30 | $1,086.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.50 / $248.50 / $248.50
| Professional | | $248.50 | $248.50 | $248.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.43 / $248.50 / $248.50
| Facility | | $234.43 | $248.50 | $248.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.50 / $248.50 / $248.50
| Professional | | $248.50 | $248.50 | $248.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.50 / $248.50 / $416.41
| Professional | | $248.50 | $248.50 | $416.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.50 / $248.50 / $263.41
| Professional | | $248.50 | $248.50 | $263.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.22 / $229.04 / $291.51
| Professional | | $208.22 | $229.04 | $291.51 |