- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.44 / $1,152.44 / $1,241.84
| Facility | | $1,152.44 | $1,152.44 | $1,241.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.61 / $600.78 / $600.78
| Professional | | $516.61 | $600.78 | $600.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.70 / $603.39 / $1,574.17
| Facility | | $480.70 | $603.39 | $1,574.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $496.74
| Professional | | $496.74 | $496.74 | $496.74 |
- 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
- $496.74 / $496.74 / $496.74
| Professional | | $496.74 | $496.74 | $496.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $601.54
| Professional | | $496.74 | $496.74 | $601.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.44 / $1,152.44 / $1,241.84
| Facility | | $1,152.44 | $1,152.44 | $1,241.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.61 / $600.78 / $1,241.84
| Professional | | $516.61 | $600.78 | $1,241.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $720.27
| Professional | | $496.74 | $496.74 | $720.27 |