- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.49 / $412.26 / $430.81
| Facility | | $218.49 | $412.26 | $430.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $240.27
| Professional | | $207.13 | $207.13 | $240.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.77 / $363.68 / $662.82
| Facility | | $225.77 | $363.68 | $662.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $207.13
| Professional | | $207.13 | $207.13 | $207.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.40 / $195.40 / $293.10
| Facility | | $195.40 | $195.40 | $293.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $207.13
| Professional | | $207.13 | $207.13 | $207.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.13 / $219.55 / $343.59
| Facility | | $206.13 | $219.55 | $343.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.77 / $227.84 / $312.77
| Professional | | $225.77 | $227.84 | $312.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $219.56
| Professional | | $207.13 | $207.13 | $219.56 |