- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.36 / $1,650.36 / $1,778.40
| Facility | | $1,650.36 | $1,650.36 | $1,778.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.32 / $604.66 / $711.36
| Professional | | $583.32 | $604.66 | $711.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.87 / $698.56 / $1,991.30
| Facility | | $558.87 | $698.56 | $1,991.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.37 / $628.37 / $628.37
| Professional | | $628.37 | $628.37 | $628.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.24 / $628.37 / $628.37
| Facility | | $471.24 | $628.37 | $628.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.37 / $628.37 / $628.37
| Professional | | $628.37 | $628.37 | $628.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.36 / $1,650.36 / $1,778.40
| Facility | | $1,650.36 | $1,650.36 | $1,778.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.32 / $604.66 / $711.36
| Professional | | $583.32 | $604.66 | $711.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.79 / $592.79 / $859.56
| Professional | | $592.79 | $592.79 | $859.56 |