- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.30 / $1,448.30 / $1,448.30
| Facility | | $1,448.30 | $1,448.30 | $1,448.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.30 / $1,448.30 / $2,237.34
| Professional | | $1,448.30 | $1,448.30 | $2,237.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $350.00 / $350.00
| Professional | | $208.25 | $350.00 | $350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,772.41 / $7,772.41 / $7,772.41
| Facility | | $7,772.41 | $7,772.41 | $7,772.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,766.29 / $1,766.29 / $1,766.29
| Facility | | $1,766.29 | $1,766.29 | $1,766.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.37 / $198.37 / $198.37
| Professional | | $198.37 | $198.37 | $198.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |