- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.40 / $364.40 / $364.40
| Facility | | $364.40 | $364.40 | $364.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.15 / $238.74 / $364.40
| Professional | | $120.15 | $238.74 | $364.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.93 / $169.40 / $180.20
| Facility | | $160.93 | $169.40 | $180.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.69 / $186.69 / $186.69
| Professional | | $186.69 | $186.69 | $186.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.02 / $291.02 / $291.02
| Facility | | $291.02 | $291.02 | $291.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.45 / $291.02 / $681.09
| Professional | | $212.45 | $291.02 | $681.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.15 / $354.65 / $2,011.56
| Facility | | $120.15 | $354.65 | $2,011.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.08 / $219.54 / $562.19
| Professional | | $124.08 | $219.54 | $562.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.30 / $196.25 / $352.04
| Facility | | $0.30 | $196.25 | $352.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.08 / $209.75 / $294.02
| Professional | | $124.08 | $209.75 | $294.02 |