- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.72 / $308.72 / $1,381.77
| Facility | | $308.72 | $308.72 | $1,381.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.72 / $308.72 / $463.69
| Professional | | $308.72 | $308.72 | $463.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.97 / $1,820.46 / $2,872.12
| Facility | | $979.97 | $1,820.46 | $2,872.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.52 / $515.52 / $515.52
| Facility | | $515.52 | $515.52 | $515.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.84 / $604.84 / $604.84
| Professional | | $604.84 | $604.84 | $604.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.42 / $463.69 / $853.91
| Facility | | $455.42 | $463.69 | $853.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $503.54 / $3,000.00
| Professional | | $55.00 | $503.54 | $3,000.00 |