- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $520.98 / $625.16
| Facility | | $416.78 | $520.98 | $625.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $539.22
| Professional | | $416.78 | $416.78 | $539.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.65 / $1,500.41 / $11,253.06
| Facility | | $562.65 | $1,500.41 | $11,253.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.14 / $562.65 / $119,998.80
| Professional | | $500.14 | $562.65 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.64 / $406.37 / $500.14
| Facility | | $338.64 | $406.37 | $500.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.88 / $2,008.88 / $2,008.88
| Professional | | $2,008.88 | $2,008.88 | $2,008.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.75 / $183.28 / $562.65
| Professional | | $160.75 | $183.28 | $562.65 |