- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.10 / $721.10 / $1,124.92
| Facility | | $721.10 | $721.10 | $1,124.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $721.10 / $721.10
| Professional | | $455.43 | $721.10 | $721.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.29 / $532.29 / $532.29
| Facility | | $532.29 | $532.29 | $532.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.68 / $532.29 / $592.05
| Professional | | $505.68 | $532.29 | $592.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.29 / $797.00 / $1,821.72
| Facility | | $569.29 | $797.00 | $1,821.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.38 / $797.00 / $1,024.72
| Professional | | $493.38 | $797.00 | $1,024.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.23 / $691.82 / $1,090.32
| Professional | | $347.23 | $691.82 | $1,090.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.10 / $721.10 / $1,325.02
| Facility | | $721.10 | $721.10 | $1,325.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.10 / $754.83 / $910.86
| Professional | | $721.10 | $754.83 | $910.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.65 / $628.50 / $848.47
| Professional | | $565.65 | $628.50 | $848.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $962.80
| Facility | | $759.05 | $759.05 | $962.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $681.98
| Professional | | $318.80 | $455.43 | $681.98 |