- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $7,079.46 / $7,079.46
| Facility | | $120.23 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $204.17
| Professional | | $120.23 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $389.05 / $389.05
| Professional | | $331.13 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $165.96
| Professional | | $120.23 | $120.23 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $48.98
| Facility | | $30.20 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $131.83
| Professional | | $120.23 | $120.23 | $131.83 |