- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.82 / $304.77 / $636.37
| Facility | | $243.82 | $304.77 | $636.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $246.15 / $295.02
| Professional | | $243.71 | $246.15 | $295.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.71 / $384.73 / $751.42
| Facility | | $243.71 | $384.73 | $751.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $252.96
| Professional | | $243.71 | $243.71 | $252.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.92 / $243.71 / $243.71
| Facility | | $229.92 | $243.71 | $243.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $252.91
| Professional | | $243.71 | $243.71 | $252.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $288.73
| Professional | | $243.71 | $243.71 | $288.73 |