- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $389.05
| Professional | | $186.21 | $251.19 | $389.05 |
- 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
- $398.11 / $398.11 / $524.81
| Professional | | $398.11 | $398.11 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $371.54
| Facility | | $338.84 | $338.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $338.84
| Professional | | $186.21 | $245.47 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $602.56
| Facility | | $295.12 | $512.86 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $223.87 / $338.84
| Professional | | $147.91 | $223.87 | $338.84 |