- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.03 / $1,643.03 / $1,643.03
| Facility | | $1,643.03 | $1,643.03 | $1,643.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.09 / $135.61 / $202.92
| Professional | | $103.09 | $135.61 | $202.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.32 / $157.11 / $231.14
| Professional | | $114.32 | $157.11 | $231.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $189.96 / $313.86
| Professional | | $128.02 | $189.96 | $313.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.07 / $187.55 / $291.83
| Professional | | $124.07 | $187.55 | $291.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.03 / $1,643.03 / $1,643.03
| Facility | | $1,643.03 | $1,643.03 | $1,643.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.09 / $147.21 / $239.94
| Professional | | $103.09 | $147.21 | $239.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.62 / $210.66 / $307.80
| Professional | | $139.62 | $210.66 | $307.80 |