- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.16 / $1,335.16 / $1,438.75
| Facility | | $1,335.16 | $1,335.16 | $1,438.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.50 / $598.52 / $733.68
| Professional | | $575.50 | $598.52 | $733.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.85 / $639.78 / $1,823.76
| Facility | | $511.85 | $639.78 | $1,823.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.50 / $575.50 / $597.22
| Professional | | $575.50 | $575.50 | $597.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.50 / $575.50 / $708.35
| Facility | | $575.50 | $575.50 | $708.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.50 / $575.50 / $575.50
| Professional | | $575.50 | $575.50 | $575.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.37 / $858.37 / $858.37
| Professional | | $858.37 | $858.37 | $858.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.50 / $575.50 / $575.50
| Professional | | $575.50 | $575.50 | $575.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.16 / $1,335.16 / $1,438.75
| Facility | | $1,335.16 | $1,335.16 | $1,438.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.50 / $604.28 / $790.33
| Professional | | $575.50 | $604.28 | $790.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.50 / $575.50 / $834.48
| Professional | | $575.50 | $575.50 | $834.48 |