- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,573.46 / $1,573.46 / $1,573.46
| Facility | | $1,573.46 | $1,573.46 | $1,573.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $503.50
| Professional | | $484.14 | $484.14 | $503.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.57 / $481.57 / $508.83
| Facility | | $481.57 | $481.57 | $508.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $484.14
| Professional | | $484.14 | $484.14 | $484.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.73 / $484.14 / $484.14
| Facility | | $456.73 | $484.14 | $484.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $484.14
| Professional | | $484.14 | $484.14 | $484.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $484.14
| Professional | | $484.14 | $484.14 | $484.14 |