- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $426.58
| Facility | | $371.54 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $602.56
| Professional | | $295.12 | $354.81 | $602.56 |
- 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
- $575.44 / $575.44 / $758.58
| Professional | | $575.44 | $575.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $549.54
| Facility | | $416.87 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $309.03 / $416.87
| Professional | | $281.84 | $309.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $776.25 / $912.01
| Facility | | $309.03 | $776.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $512.86
| Professional | | $223.87 | $331.13 | $512.86 |