- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.76 / $339.65 / $520.59
| Facility | | $330.76 | $339.65 | $520.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.66 / $520.59 / $520.59
| Professional | | $410.66 | $520.59 | $520.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,671.00 / $20,132.00 / $31,549.00
| Facility | | $19,671.00 | $20,132.00 | $31,549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.94 / $185.55 / $287.94
| Professional | | $142.94 | $185.55 | $287.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,758.40 / $6,758.40 / $6,758.40
| Professional | | $6,758.40 | $6,758.40 | $6,758.40 |