- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.20 / $1,151.20 / $1,151.20
| Facility | | $1,151.20 | $1,151.20 | $1,151.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.48 / $477.75 / $489.26
| Professional | | $460.48 | $477.75 | $489.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.66 / $1,809.58 / $3,170.86
| Facility | | $484.66 | $1,809.58 | $3,170.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.43 / $508.43 / $528.86
| Facility | | $508.43 | $508.43 | $528.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.43 / $508.43 / $508.43
| Professional | | $508.43 | $508.43 | $508.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.24 / $508.43 / $938.23
| Facility | | $466.24 | $508.43 | $938.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.60 / $575.60 / $610.14
| Professional | | $575.60 | $575.60 | $610.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.60 / $575.60 / $610.14
| Professional | | $575.60 | $575.60 | $610.14 |