- 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
- $41.69 / $81.28 / $186.21
| Professional | | $41.69 | $81.28 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $72.44 / $125.89
| Professional | | $41.69 | $72.44 | $125.89 |
- 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
- $40.74 / $70.79 / $107.15
| Professional | | $40.74 | $70.79 | $107.15 |