- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.65 / $1,550.19 / $10,393.62
| Facility | | $958.65 | $1,550.19 | $10,393.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.65 / $958.65 / $958.65
| Professional | | $958.65 | $958.65 | $958.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.75 / $981.75 / $981.75
| Professional | | $981.75 | $981.75 | $981.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.24 / $1,932.88 / $3,638.48
| Facility | | $1,530.24 | $1,932.88 | $3,638.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.25 / $1,352.03 / $1,423.13
| Professional | | $1,097.25 | $1,352.03 | $1,423.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.50 / $962.50 / $962.50
| Professional | | $962.50 | $962.50 | $962.50 |