- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.77 / $294.77 / $368.46
| Facility | | $294.77 | $294.77 | $368.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.46 / $368.46 / $368.46
| Professional | | $368.46 | $368.46 | $368.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,919.65 / $2,329.59 / $3,134.04
| Facility | | $1,919.65 | $2,329.59 | $3,134.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,361.84 / $12,576.48 / $22,546.18
| Facility | | $7,361.84 | $12,576.48 | $22,546.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,972.93 / $8,658.77 / $11,830.80
| Facility | | $7,972.93 | $8,658.77 | $11,830.80 |