- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,154.83 / $2,154.83 / $2,154.83
| Facility | | $2,154.83 | $2,154.83 | $2,154.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.43 / $2,154.83 / $2,154.83
| Professional | | $1,606.43 | $2,154.83 | $2,154.83 |
- 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
- $3,346.80 / $4,429.59 / $4,921.77
| Professional | | $3,346.80 | $4,429.59 | $4,921.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,763.92 / $3,763.92 / $3,877.26
| Facility | | $3,763.92 | $3,763.92 | $3,877.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,763.92 / $3,763.92 / $3,763.92
| Professional | | $3,763.92 | $3,763.92 | $3,763.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.75 / $2,326.75 / $3,101.47
| Facility | | $2,326.75 | $2,326.75 | $3,101.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.53 / $2,326.75 / $3,028.78
| Professional | | $1,698.53 | $2,326.75 | $3,028.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.77 / $1,746.34 / $2,330.78
| Professional | | $1,145.77 | $1,746.34 | $2,330.78 |