- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.50 / $1,127.50 / $1,127.50
| Facility | | $1,127.50 | $1,127.50 | $1,127.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.60 / $1,553.50 / $2,232.07
| Professional | | $841.60 | $1,553.50 | $2,232.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.43 / $1,959.71 / $6,608.00
| Facility | | $1,501.43 | $1,959.71 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.40 / $1,747.79 / $2,034.84
| Facility | | $1,308.40 | $1,747.79 | $2,034.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |