- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,145.00 / $13,413.92 / $49,221.22
| Facility | | $9,145.00 | $13,413.92 | $49,221.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.30 / $673.30 / $673.30
| Professional | | $673.30 | $673.30 | $673.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.25 / $362.25 / $362.25
| Professional | | $362.25 | $362.25 | $362.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.30 / $942.62 / $962.82
| Facility | | $673.30 | $942.62 | $962.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.30 / $942.62 / $962.82
| Facility | | $673.30 | $942.62 | $962.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.25 / $362.25 / $362.25
| Professional | | $362.25 | $362.25 | $362.25 |