- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.47 / $1,179.35 / $2,256.61
| Facility | | $501.47 | $1,179.35 | $2,256.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $501.71 / $501.71
| Professional | | $496.74 | $501.71 | $501.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.74 / $993.48 / $1,316.36
| Facility | | $496.74 | $993.48 | $1,316.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.22 / $496.74 / $705.37
| Professional | | $422.22 | $496.74 | $705.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $670.60
| Facility | | $496.74 | $496.74 | $670.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $620.92
| Professional | | $496.74 | $496.74 | $620.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $496.74
| Facility | | $496.74 | $496.74 | $496.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.77 / $496.74 / $1,351.35
| Professional | | $481.77 | $496.74 | $1,351.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $556.35 / $590.62
| Professional | | $496.74 | $556.35 | $590.62 |