- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.56 / $368.56 / $368.56
| Facility | | $368.56 | $368.56 | $368.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.56 / $386.94 / $421.22
| Professional | | $368.56 | $386.94 | $421.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.56 / $402.56 / $402.56
| Facility | | $402.56 | $402.56 | $402.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.87 / $402.56 / $402.56
| Professional | | $293.87 | $402.56 | $402.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.50 / $515.91 / $3,601.96
| Facility | | $207.50 | $515.91 | $3,601.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.27 / $424.72 / $838.86
| Professional | | $214.27 | $424.72 | $838.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.27 / $387.32 / $484.26
| Professional | | $214.27 | $387.32 | $484.26 |