- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $537.03
| Professional | | $169.82 | $302.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $354.81
| Professional | | $158.49 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $407.38 / $524.81
| Professional | 50 | $234.42 | $407.38 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $407.38 / $676.08
| Professional | | $223.87 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $371.54 / $630.96
| Professional | | $194.98 | $371.54 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $323.59 / $645.65
| Professional | | $173.78 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $331.13 / $549.54
| Professional | | $194.98 | $331.13 | $549.54 |