- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $588.84
| Professional | | $275.42 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218,776.16 / $524,807.46 / $954,992.59
| Facility | | $218,776.16 | $524,807.46 | $954,992.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $977.24
| Professional | | $741.31 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $691.83
| Facility | | $407.38 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $302.00 / $407.38
| Professional | | $275.42 | $302.00 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $758.58 / $891.25
| Facility | | $245.47 | $758.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $398.11 / $501.19
| Professional | | $218.78 | $398.11 | $501.19 |