- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.63 / $1,295.63 / $1,396.15
| Facility | | $1,295.63 | $1,295.63 | $1,396.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.78 / $675.86 / $675.86
| Professional | | $580.78 | $675.86 | $675.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.41 / $678.36 / $1,769.76
| Facility | | $540.41 | $678.36 | $1,769.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.46 / $558.46 / $558.46
| Professional | | $558.46 | $558.46 | $558.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.46 / $558.46 / $558.46
| Facility | | $558.46 | $558.46 | $558.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.46 / $558.46 / $558.46
| Professional | | $558.46 | $558.46 | $558.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.46 / $558.46 / $676.30
| Professional | | $558.46 | $558.46 | $676.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.63 / $1,295.63 / $1,396.15
| Facility | | $1,295.63 | $1,295.63 | $1,396.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.78 / $675.86 / $1,396.15
| Professional | | $580.78 | $675.86 | $1,396.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.55 / $558.46 / $837.69
| Professional | | $536.55 | $558.46 | $837.69 |