- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.20 / $1,307.20 / $1,307.20
| Facility | | $1,307.20 | $1,307.20 | $1,307.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.12 / $130.12 / $203.40
| Professional | | $130.12 | $130.12 | $203.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.00 / $316.00 / $526.00
| Professional | | $217.00 | $316.00 | $526.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.82 / $278.83 / $408.03
| Professional | | $186.82 | $278.83 | $408.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.06 / $591.15 / $846.12
| Professional | | $260.06 | $591.15 | $846.12 |