- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.45 / $6,653.38 / $6,653.38
| Professional | | $1,337.45 | $6,653.38 | $6,653.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,032.74 / $2,032.74 / $2,032.74
| Facility | | $2,032.74 | $2,032.74 | $2,032.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.15 / $2,032.74 / $2,111.50
| Professional | | $1,401.15 | $2,032.74 | $2,111.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.91 / $2,161.25 / $2,366.17
| Facility | | $996.91 | $2,161.25 | $2,366.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.65 / $1,876.17 / $2,706.20
| Professional | | $1,250.65 | $1,876.17 | $2,706.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.75 / $2,113.96 / $3,593.63
| Professional | | $1,695.75 | $2,113.96 | $3,593.63 |