- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.69 / $305.29 / $331.35
| Professional | | $239.69 | $305.29 | $331.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.41 / $305.41 / $305.41
| Professional | | $305.41 | $305.41 | $305.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.14 / $291.45 / $291.45
| Professional | | $268.14 | $291.45 | $291.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.00 / $754.00 / $754.00
| Facility | | $754.00 | $754.00 | $754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.52 / $209.52 / $436.75
| Facility | | $209.52 | $209.52 | $436.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.65 / $209.52 / $517.50
| Professional | | $31.65 | $209.52 | $517.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.60 / $208.17 / $300.68
| Professional | | $126.60 | $208.17 | $300.68 |