- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,584.89 / $4,365.16
| Facility | | $891.25 | $1,584.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $2,344.23 / $3,162.28
| Professional | | $120.23 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $512.86
| Facility | | $489.78 | $489.78 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $707.95
| Facility | | $446.68 | $446.68 | $707.95 |