- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.26 / $285.26 / $285.26
| Facility | | $285.26 | $285.26 | $285.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.27 / $285.26 / $285.26
| Professional | | $246.27 | $285.26 | $285.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.16 / $521.34 / $850.76
| Professional | | $357.16 | $521.34 | $850.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.26 / $326.88 / $603.54
| Facility | | $285.26 | $326.88 | $603.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.08 / $309.08 / $309.08
| Professional | | $309.08 | $309.08 | $309.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.50 / $432.50 / $432.50
| Professional | | $432.50 | $432.50 | $432.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.00 / $451.00 / $717.00
| Professional | | $439.00 | $451.00 | $717.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.26 / $3,728.65 / $3,728.65
| Facility | | $522.26 | $3,728.65 | $3,728.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.54 / $1,819.54 / $2,338.50
| Professional | | $1,819.54 | $1,819.54 | $2,338.50 |