- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.78 / $311.73 / $751.52
| Professional | | $152.78 | $311.73 | $751.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.47 / $236.54 / $329.57
| Professional | | $154.47 | $236.54 | $329.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.39 / $210.39 / $699.00
| Facility | | $210.39 | $210.39 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.99 / $261.81 / $469.68
| Professional | | $162.99 | $261.81 | $469.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.93 / $253.50 / $449.94
| Professional | | $152.93 | $253.50 | $449.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.78 / $311.73 / $751.53
| Professional | | $152.78 | $311.73 | $751.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.56 / $266.58 / $435.67
| Professional | | $193.56 | $266.58 | $435.67 |