- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.49 / $702.18 / $1,299.76
| Facility | | $320.49 | $702.18 | $1,299.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.74 / $317.60 / $317.60
| Professional | | $207.74 | $317.60 | $317.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.76 / $310.88 / $518.44
| Professional | | $49.76 | $310.88 | $518.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.32 / $230.32 / $230.32
| Facility | | $230.32 | $230.32 | $230.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.76 / $116.76 / $116.76
| Professional | | $116.76 | $116.76 | $116.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.60 / $317.60 / $444.64
| Facility | | $317.60 | $317.60 | $444.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $290.02
| Facility | | $100.00 | $100.00 | $290.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.30 / $256.30 / $329.53
| Professional | | $256.30 | $256.30 | $329.53 |