- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.38 / $352.38 / $503.40
| Facility | | $352.38 | $352.38 | $503.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.38 / $352.38 / $352.38
| Professional | | $352.38 | $352.38 | $352.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.88 / $1,014.35 / $1,138.31
| Professional | | $836.88 | $1,014.35 | $1,138.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.00 / $530.25 / $656.25
| Professional | | $525.00 | $530.25 | $656.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.38 / $599.04 / $2,391.15
| Facility | | $352.38 | $599.04 | $2,391.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.43 / $503.40 / $729.93
| Professional | | $211.43 | $503.40 | $729.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.43 / $513.47 / $729.93
| Professional | | $211.43 | $513.47 | $729.93 |