- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $354.81
| Facility | | $223.87 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $446.68
| Professional | | $173.78 | $239.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $251.19
| Professional | | $194.98 | $194.98 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $302.00
| Facility | | $181.97 | $281.84 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $199.53 / $309.03
| Professional | | $134.90 | $199.53 | $309.03 |