- 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
- $346.74 / $389.05 / $645.65
| Professional | | $346.74 | $389.05 | $645.65 |
- 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
- $645.65 / $645.65 / $691.83
| Facility | | $645.65 | $645.65 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $645.65
| Professional | | $338.84 | $478.63 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $933.25 / $1,096.48
| Facility | | $363.08 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $616.60
| Professional | | $269.15 | $407.38 | $616.60 |