- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.51 / $1,183.78 / $1,519.28
| Facility | | $1,044.51 | $1,183.78 | $1,519.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.02 / $671.02 / $671.02
| Professional | | $671.02 | $671.02 | $671.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.28 / $1,519.28 / $1,519.28
| Professional | | $1,519.28 | $1,519.28 | $1,519.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,266.07 / $1,582.59
| Professional | | $1,266.07 | $1,266.07 | $1,582.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.68 / $1,519.28 / $1,772.50
| Professional | | $1,392.68 | $1,519.28 | $1,772.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,519.28 / $1,899.11
| Professional | | $1,266.07 | $1,519.28 | $1,899.11 |