- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,202.26
| Facility | | $398.11 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,862.09 / $2,187.76
| Facility | | $398.11 | $1,862.09 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,698.24 / $2,570.40
| Facility | | $380.19 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $50.12
| Professional | | $47.86 | $47.86 | $50.12 |