- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,096.01 / $8,096.01 / $8,096.01
| Facility | | $8,096.01 | $8,096.01 | $8,096.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,145.54 / $8,096.01 / $9,404.08
| Professional | | $7,145.54 | $8,096.01 | $9,404.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219,999.78 / $539,999.46 / $949,999.05
| Facility | | $219,999.78 | $539,999.46 | $949,999.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,010.00 / $17,219.12 / $19,132.36
| Professional | | $13,010.00 | $17,219.12 | $19,132.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.22 / $1,546.22 / $1,546.22
| Facility | | $1,546.22 | $1,546.22 | $1,546.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.22 / $1,546.22 / $1,546.22
| Professional | | $1,546.22 | $1,546.22 | $1,546.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.81 / $10,777.03 / $11,620.16
| Professional | | $1,092.81 | $10,777.03 | $11,620.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,338.26 / $5,926.28 / $10,288.95
| Professional | | $4,338.26 | $5,926.28 | $10,288.95 |