- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.99 / $112.99 / $275.83
| Professional | | $112.99 | $112.99 | $275.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.16 / $330.06 / $441.26
| Facility | | $147.16 | $330.06 | $441.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.40 / $678.40 / $678.40
| Professional | | $678.40 | $678.40 | $678.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.75 / $2,000.00 / $15,000.00
| Facility | | $270.75 | $2,000.00 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.00 / $3,046.00 / $3,046.00
| Professional | | $1,021.00 | $3,046.00 | $3,046.00 |