- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.67 / $307.14 / $594.87
| Professional | | $195.67 | $307.14 | $594.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.40 / $390.71 / $665.21
| Professional | | $230.40 | $390.71 | $665.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.67 / $176.67 / $176.67
| Professional | | $176.67 | $176.67 | $176.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.75 / $362.82 / $661.94
| Professional | | $222.75 | $362.82 | $661.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.79 / $334.90 / $509.64
| Professional | | $221.79 | $334.90 | $509.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $608.40 / $819.70
| Professional | | $5.00 | $608.40 | $819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.44 / $373.56 / $704.08
| Professional | | $274.44 | $373.56 | $704.08 |