- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $7,244.36
| Facility | | $3,235.94 | $3,235.94 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $141.25 / $194.98
| Professional | | $60.26 | $141.25 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $117.49 / $245.47
| Professional | | $60.26 | $117.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $128.82 / $316.23
| Professional | | $56.23 | $128.82 | $316.23 |