- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.45 / $593.52 / $593.52
| Facility | | $440.45 | $593.52 | $593.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.45 / $593.52 / $593.52
| Professional | | $440.45 | $593.52 | $593.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.58 / $1,345.97 / $1,421.49
| Facility | | $1,184.58 | $1,345.97 | $1,421.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.41 / $453.41 / $453.41
| Professional | | $453.41 | $453.41 | $453.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.73 / $457.73 / $457.73
| Facility | | $457.73 | $457.73 | $457.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.73 / $457.73 / $518.17
| Professional | | $457.73 | $457.73 | $518.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $627.00 / $627.00
| Facility | | $627.00 | $627.00 | $627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.73 / $457.73 / $457.73
| Professional | | $457.73 | $457.73 | $457.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.17 / $518.17 / $673.63
| Professional | | $518.17 | $518.17 | $673.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.17 / $732.37 / $1,313.95
| Facility | | $518.17 | $732.37 | $1,313.95 |