- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $309.03
| Facility | | $128.82 | $223.87 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $162.18 / $162.18
| Professional | | $120.23 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $691.83
| Facility | | $363.08 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $501.19
| Professional | | $223.87 | $281.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |