- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.26 / $230.26 / $30,454.93
| Facility | | $230.26 | $230.26 | $30,454.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.26 / $294.73
| Professional | | $230.15 | $230.26 | $294.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.16 / $230.16 / $230.26
| Professional | | $230.16 | $230.16 | $230.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $293.12
| Professional | | $230.15 | $230.15 | $293.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $241.21
| Professional | | $230.15 | $230.15 | $241.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $243.96
| Professional | | $230.15 | $230.15 | $243.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.52 / $223.52 / $223.52
| Professional | | $223.52 | $223.52 | $223.52 |