- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $630.96 / $630.96
| Professional | | $575.44 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $74.13 / $74.13
| Professional | | $46.77 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,000.00 / $1,000.00
| Professional | | $851.14 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $602.56 / $812.83
| Facility | | $81.28 | $602.56 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $1,071.52
| Professional | | $389.05 | $645.65 | $1,071.52 |