- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.46 / $197.71 / $262.37
| Professional | | $155.46 | $197.71 | $262.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $98.86 / $296.58 / $324.68
| Professional | 50 | $98.86 | $296.58 | $324.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.33 / $200.33 / $253.44
| Professional | | $200.33 | $200.33 | $253.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.33 / $200.33 / $200.33
| Facility | | $200.33 | $200.33 | $200.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $233.18 / $396.34
| Professional | | $128.82 | $233.18 | $396.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.34 / $201.25 / $700.00
| Facility | | $113.34 | $201.25 | $700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.97 / $198.43 / $301.20
| Professional | | $128.97 | $198.43 | $301.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $200.00
| Facility | | $200.00 | $200.00 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.75 / $270.58 / $361.12
| Professional | | $236.75 | $270.58 | $361.12 |