- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.59 / $1,140.59 / $1,140.59
| Facility | | $1,140.59 | $1,140.59 | $1,140.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.21 / $1,059.21 / $1,059.21
| Professional | | $1,059.21 | $1,059.21 | $1,059.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.72 / $353.02 / $436.61
| Professional | | $42.72 | $353.02 | $436.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.31 / $2,149.55 / $2,386.46
| Facility | | $1,788.31 | $2,149.55 | $2,386.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.33 / $1,059.21 / $1,122.76
| Facility | | $900.33 | $1,059.21 | $1,122.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.65 / $1,235.65 / $2,138.63
| Facility | | $1,235.65 | $1,235.65 | $2,138.63 |