- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.77 / $993.59 / $1,060.57
| Professional | | $433.77 | $993.59 | $1,060.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.94 / $89.99 / $310.00
| Facility | | $52.94 | $89.99 | $310.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.67 / $62.48 / $72.63
| Professional | | $54.67 | $62.48 | $72.63 |
- 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
- $433.77 / $498.84 / $1,060.57
| Facility | | $433.77 | $498.84 | $1,060.57 |