- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.51 / $1,870.51 / $1,870.51
| Facility | | $1,870.51 | $1,870.51 | $1,870.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.51 / $1,870.51 / $1,881.58
| Professional | | $1,870.51 | $1,870.51 | $1,881.58 |
- 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
- $3,083.92 / $4,081.66 / $4,535.18
| Professional | | $3,083.92 | $4,081.66 | $4,535.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.16 / $384.16 / $407.16
| Facility | | $384.16 | $384.16 | $407.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.16 / $384.16 / $384.16
| Professional | | $384.16 | $384.16 | $384.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.76 / $2,837.98 / $2,837.98
| Professional | | $287.76 | $2,837.98 | $2,837.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.76 / $1,466.72 / $2,281.42
| Professional | | $1,027.76 | $1,466.72 | $2,281.42 |