- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.06 / $1,555.15 / $3,741.13
| Facility | | $1,096.06 | $1,555.15 | $3,741.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.13 / $537.08 / $620.08
| Professional | | $493.13 | $537.08 | $620.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.42 / $1,421.78 / $2,945.78
| Facility | | $996.42 | $1,421.78 | $2,945.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.25 / $488.25 / $488.25
| Professional | | $488.25 | $488.25 | $488.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.13 / $1,092.13 / $1,092.13
| Facility | | $1,092.13 | $1,092.13 | $1,092.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,864.98 / $1,864.98 / $1,864.98
| Professional | | $1,864.98 | $1,864.98 | $1,864.98 |