- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.65 / $785.65 / $785.65
| Facility | | $785.65 | $785.65 | $785.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.70 / $785.65 / $785.65
| Professional | | $585.70 | $785.65 | $785.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219,999.78 / $539,999.46 / $949,999.05
| Facility | | $219,999.78 | $539,999.46 | $949,999.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.25 / $1,615.03 / $1,794.48
| Professional | | $1,220.25 | $1,615.03 | $1,794.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.31 / $1,372.31 / $1,413.63
| Facility | | $1,372.31 | $1,372.31 | $1,413.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.31 / $1,372.31 / $1,372.31
| Professional | | $1,372.31 | $1,372.31 | $1,372.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.46 / $907.46 / $1,130.80
| Facility | | $907.46 | $907.46 | $1,130.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.45 / $907.46 / $1,104.30
| Professional | | $662.45 | $907.46 | $1,104.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.75 / $636.72 / $944.47
| Professional | | $417.75 | $636.72 | $944.47 |