- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.86 / $231.95 / $91,103.76
| Facility | | $231.86 | $231.95 | $91,103.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $231.86 / $272.48
| Professional | | $225.11 | $231.86 | $272.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.50 / $490.97 / $935.52
| Facility | | $261.50 | $490.97 | $935.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $234.82
| Professional | | $225.11 | $225.11 | $234.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.11 / $278.33 / $723.68
| Facility | | $225.11 | $278.33 | $723.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $231.86 / $270.13
| Professional | | $225.11 | $231.86 | $270.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.36 / $258.87 / $258.96
| Professional | | $253.36 | $258.87 | $258.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $224.97 / $224.97
| Facility | | $224.97 | $224.97 | $224.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $270.13
| Professional | | $225.11 | $225.11 | $270.13 |