- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,622.40 / $7,622.40 / $7,622.40
| Facility | | $7,622.40 | $7,622.40 | $7,622.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,546.81 / $7,622.40 / $7,622.40
| Professional | | $4,546.81 | $7,622.40 | $7,622.40 |
- 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
- $11,838.85 / $15,669.06 / $17,410.07
| Professional | | $11,838.85 | $15,669.06 | $17,410.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,616.81 / $10,616.81 / $11,003.20
| Facility | | $10,616.81 | $10,616.81 | $11,003.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,003.20 / $11,003.20 / $11,003.20
| Professional | | $11,003.20 | $11,003.20 | $11,003.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,302.44 / $8,302.44 / $10,971.02
| Facility | | $8,302.44 | $8,302.44 | $10,971.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,060.78 / $8,302.44 / $10,713.89
| Professional | | $6,060.78 | $8,302.44 | $10,713.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,531.07 / $6,841.65 / $8,244.79
| Professional | | $3,531.07 | $6,841.65 | $8,244.79 |