- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.65 / $376.74 / $9,972.60
| Facility | | $178.65 | $376.74 | $9,972.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.62 / $377.85 / $435.34
| Facility | | $314.62 | $377.85 | $435.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $55,249.45 / $55,249.45
| Professional | | $55,249.45 | $55,249.45 | $55,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.20 / $380.40 / $824.88
| Facility | | $344.20 | $380.40 | $824.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $3,352.00 / $10,536.00
| Facility | | $1,529.00 | $3,352.00 | $10,536.00 |