- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.57 / $363.12 / $363.12
| Professional | | $235.57 | $363.12 | $363.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.86 / $258.04 / $404.77
| Professional | | $242.86 | $258.04 | $404.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.68 / $252.68 / $396.28
| Facility | | $252.68 | $252.68 | $396.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.10 / $194.10 / $252.68
| Professional | | $194.10 | $194.10 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.54 / $436.54 / $436.54
| Professional | | $436.54 | $436.54 | $436.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.58 / $363.12 / $363.12
| Professional | | $303.58 | $363.12 | $363.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.32 / $303.95 / $618.57
| Professional | | $179.32 | $303.95 | $618.57 |