- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.57 / $679.57 / $1,698.93
| Facility | | $679.57 | $679.57 | $1,698.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.45 / $550.45 / $679.57
| Professional | | $550.45 | $550.45 | $679.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.62 / $825.47 / $2,349.27
| Facility | | $657.62 | $825.47 | $2,349.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.83 / $299.01 / $2,289.64
| Professional | | $271.83 | $299.01 | $2,289.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.50 / $1,449.50 / $1,449.50
| Facility | | $1,449.50 | $1,449.50 | $1,449.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.39 / $718.28 / $976.23
| Professional | | $610.39 | $718.28 | $976.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.57 / $679.57 / $686.37
| Professional | | $679.57 | $679.57 | $686.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.57 / $679.57 / $1,698.93
| Facility | | $679.57 | $679.57 | $1,698.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.45 / $679.57 / $679.57
| Professional | | $550.45 | $679.57 | $679.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $407.74 / $985.38
| Professional | | $407.74 | $407.74 | $985.38 |