- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.44 / $1,711.38 / $4,344.54
| Facility | | $738.44 | $1,711.38 | $4,344.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.44 / $738.44 / $738.44
| Professional | | $738.44 | $738.44 | $738.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.54 / $857.63 / $1,044.58
| Facility | | $660.54 | $857.63 | $1,044.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.59 / $636.59 / $636.59
| Professional | | $636.59 | $636.59 | $636.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.00 / $1,401.48 / $1,890.37
| Facility | | $1,056.00 | $1,401.48 | $1,890.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.76 / $636.59 / $636.59
| Professional | | $604.76 | $636.59 | $636.59 |