- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.04 / $231.05 / $381.33
| Professional | | $209.04 | $231.05 | $381.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.78 / $440.00 / $461.04
| Facility | | $363.78 | $440.00 | $461.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.46 / $681.46 / $681.46
| Professional | | $681.46 | $681.46 | $681.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |