- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.88 / $1,227.88 / $1,323.15
| Facility | | $1,227.88 | $1,227.88 | $1,323.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.25 / $550.42 / $634.05
| Professional | | $529.25 | $550.42 | $634.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.16 / $642.89 / $1,677.22
| Facility | | $512.16 | $642.89 | $1,677.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.26 / $529.26 / $529.26
| Professional | | $529.26 | $529.26 | $529.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.26 / $529.26 / $529.26
| Facility | | $529.26 | $529.26 | $529.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.26 / $529.26 / $529.26
| Professional | | $529.26 | $529.26 | $529.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.26 / $529.26 / $640.92
| Professional | | $529.26 | $529.26 | $640.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.88 / $1,227.88 / $1,323.15
| Facility | | $1,227.88 | $1,227.88 | $1,323.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.25 / $550.64 / $726.83
| Professional | | $529.25 | $550.64 | $726.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.26 / $529.26 / $793.89
| Professional | | $529.26 | $529.26 | $793.89 |