- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.15 / $567.36 / $1,688.53
| Facility | | $246.15 | $567.36 | $1,688.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $246.15 / $268.08
| Professional | | $243.71 | $246.15 | $268.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.71 / $487.42 / $589.78
| Facility | | $243.71 | $487.42 | $589.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.98 / $13.44 / $243.71
| Professional | | $9.98 | $13.44 | $243.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $365.57
| Facility | | $243.71 | $243.71 | $365.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $304.64
| Professional | | $243.71 | $243.71 | $304.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $243.71
| Facility | | $243.71 | $243.71 | $243.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $275.89
| Professional | | $243.71 | $243.71 | $275.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $258.33 / $288.73
| Professional | | $243.71 | $258.33 | $288.73 |