- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.56 / $1,084.56 / $1,084.56
| Facility | | $1,084.56 | $1,084.56 | $1,084.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.33 / $260.33 / $260.33
| Professional | | $260.33 | $260.33 | $260.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.88 / $998.00 / $1,860.77
| Facility | | $288.88 | $998.00 | $1,860.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.56 / $1,084.56 / $1,644,227.32
| Facility | | $1,084.56 | $1,084.56 | $1,644,227.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.60 / $1,258.55 / $1,551.28
| Facility | | $1,037.60 | $1,258.55 | $1,551.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.46 / $1,221.46 / $1,509.19
| Facility | | $1,221.46 | $1,221.46 | $1,509.19 |