- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,300.00 / $3,500.00
| Facility | | $497.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.10 / $988.59 / $988.59
| Professional | | $362.10 | $988.59 | $988.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,550.38 / $8,027.55 / $11,275.88
| Facility | | $3,550.38 | $8,027.55 | $11,275.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.99 / $496.64 / $925.60
| Professional | | $334.99 | $496.64 | $925.60 |