- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.55 / $534.42 / $548.24
| Professional | | $244.55 | $534.42 | $548.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.92 / $270.62 / $444.14
| Facility | | $195.92 | $270.62 | $444.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.66 / $721.02 / $963.46
| Professional | | $523.66 | $721.02 | $963.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.14 / $107.05 / $159.83
| Professional | | $74.14 | $107.05 | $159.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.74 / $103.18 / $186.12
| Professional | | $85.74 | $103.18 | $186.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.55 / $534.42 / $548.24
| Professional | | $244.55 | $534.42 | $548.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.52 / $521.92 / $1,186.75
| Professional | | $394.52 | $521.92 | $1,186.75 |