- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.40 / $1,328.40 / $1,944.00
| Facility | | $1,328.40 | $1,328.40 | $1,944.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,377.00 / $1,944.00
| Professional | | $1,296.00 | $1,377.00 | $1,944.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.00 / $1,377.00 / $1,377.00
| Facility | | $1,377.00 | $1,377.00 | $1,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.00 / $1,377.00 / $1,377.00
| Professional | | $1,377.00 | $1,377.00 | $1,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.25 / $45.00 / $50.00
| Professional | | $38.25 | $45.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.25 / $1,350.00 / $1,755.00
| Professional | | $1,276.25 | $1,350.00 | $1,755.00 |