- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.37 / $1,470.64 / $3,565.80
| Facility | | $798.37 | $1,470.64 | $3,565.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.20 / $798.38 / $798.38
| Professional | | $692.20 | $798.38 | $798.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.00 / $681.00 / $681.00
| Facility | | $681.00 | $681.00 | $681.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.00 / $681.00 / $681.00
| Professional | | $681.00 | $681.00 | $681.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.51 / $291.51 / $291.51
| Professional | | $291.51 | $291.51 | $291.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $21.25 / $50.00
| Professional | | $17.00 | $21.25 | $50.00 |