- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.67 / $404.67 / $404.67
| Professional | | $404.67 | $404.67 | $404.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.38 / $373.38 / $373.38
| Facility | | $373.38 | $373.38 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.37 / $317.37 / $317.37
| Professional | | $317.37 | $317.37 | $317.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.32 / $135.32 / $135.32
| Facility | | $135.32 | $135.32 | $135.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.17 / $532.17 / $532.17
| Professional | | $532.17 | $532.17 | $532.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.32 / $135.32 / $373.38
| Facility | | $135.32 | $135.32 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.37 / $404.46 / $656.47
| Professional | | $317.37 | $404.46 | $656.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.47 / $279.47 / $535.66
| Professional | | $279.47 | $279.47 | $535.66 |