- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.64 / $502.64 / $502.64
| Professional | | $502.64 | $502.64 | $502.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.42 / $340.42 / $340.42
| Facility | | $340.42 | $340.42 | $340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.51 / $340.42 / $350.63
| Professional | | $248.51 | $340.42 | $350.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.69 / $161.69 / $161.69
| Facility | | $161.69 | $161.69 | $161.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.93 / $545.30 / $861.02
| Professional | | $476.93 | $545.30 | $861.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.69 / $161.69 / $340.42
| Facility | | $161.69 | $161.69 | $340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.51 / $350.63 / $579.82
| Professional | | $248.51 | $350.63 | $579.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.43 / $286.37 / $548.87
| Professional | | $277.43 | $286.37 | $548.87 |