- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,316.00 / $6,907.00 / $7,059.45
| Facility | | $6,316.00 | $6,907.00 | $7,059.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.27 / $272.39 / $272.39
| Professional | | $241.27 | $272.39 | $272.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.10 / $289.80 / $512.03
| Professional | | $238.10 | $289.80 | $512.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.00 / $143.00 / $143.00
| Facility | | $143.00 | $143.00 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.71 / $332.18 / $634.60
| Professional | | $234.71 | $332.18 | $634.60 |