- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $495.73
| Professional | | $400.00 | $400.00 | $495.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.78 / $1,965.78 / $1,979.51
| Facility | | $1,965.78 | $1,965.78 | $1,979.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.68 / $1,299.68 / $1,299.68
| Facility | | $1,299.68 | $1,299.68 | $1,299.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.45 / $136.81 / $530.09
| Professional | | $109.45 | $136.81 | $530.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.68 / $1,299.68 / $1,299.68
| Facility | | $1,299.68 | $1,299.68 | $1,299.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.45 / $136.81 / $530.09
| Professional | | $109.45 | $136.81 | $530.09 |