- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.70 / $469.06 / $562.88
| Facility | | $307.70 | $469.06 | $562.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.44 / $307.70 / $318.95
| Professional | | $281.44 | $307.70 | $318.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.59 / $2,110.78 / $10,131.76
| Facility | | $506.59 | $2,110.78 | $10,131.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.30 / $506.59 / $119,998.80
| Professional | | $450.30 | $506.59 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.89 / $450.30 / $1,125.64
| Facility | | $304.89 | $450.30 | $1,125.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.71 / $1,808.71 / $1,808.71
| Professional | | $1,808.71 | $1,808.71 | $1,808.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $187.63 / $544.11
| Professional | | $157.61 | $187.63 | $544.11 |