- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.99 / $145.99 / $8,500.00
| Facility | | $145.99 | $145.99 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.50 / $194.84 / $278.70
| Professional | | $138.50 | $194.84 | $278.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.16 / $303.79 / $356.21
| Professional | | $276.16 | $303.79 | $356.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.50 / $340.09 / $453.00
| Professional | | $204.50 | $340.09 | $453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.99 / $234.61 / $437.97
| Facility | | $145.99 | $234.61 | $437.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.13 / $274.05 / $378.15
| Professional | | $167.13 | $274.05 | $378.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.94 / $267.82 / $334.27
| Professional | | $151.94 | $267.82 | $334.27 |