- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,235.07 / $2,534.07 / $9,583.96
| Facility | | $2,235.07 | $2,534.07 | $9,583.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.68 / $986.02 / $986.02
| Professional | | $869.68 | $986.02 | $986.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.29 / $1,004.39 / $1,474.55
| Professional | | $847.29 | $1,004.39 | $1,474.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,177.45 / $7,177.45 / $7,177.45
| Facility | | $7,177.45 | $7,177.45 | $7,177.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.68 / $1,174.80 / $2,584.56
| Professional | | $810.68 | $1,174.80 | $2,584.56 |