- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,071.52
| Professional | | $602.56 | $758.58 | $1,071.52 |
- 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
- $1,148.15 / $1,148.15 / $1,548.82
| Professional | | $1,148.15 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,096.48
| Facility | | $831.76 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $616.60 / $831.76
| Professional | | $562.34 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,548.82 / $1,819.70
| Facility | | $660.69 | $1,548.82 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $851.14
| Professional | | $446.68 | $645.65 | $851.14 |