- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.35 / $957.35 / $957.35
| Facility | | $957.35 | $957.35 | $957.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.17 / $957.35 / $957.35
| Professional | | $660.17 | $957.35 | $957.35 |
- 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
- $1,486.91 / $1,967.97 / $2,186.63
| Professional | | $1,486.91 | $1,967.97 | $2,186.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.50 / $1,541.50 / $1,541.50
| Facility | | $1,541.50 | $1,541.50 | $1,541.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.50 / $1,541.50 / $1,541.50
| Professional | | $1,541.50 | $1,541.50 | $1,541.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.22 / $963.22 / $1,377.91
| Facility | | $963.22 | $963.22 | $1,377.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.15 / $963.22 / $1,345.62
| Professional | | $703.15 | $963.22 | $1,345.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.69 / $859.28 / $1,176.83
| Professional | | $512.69 | $859.28 | $1,176.83 |