- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,449.54 / $25,449.54 / $25,449.54
| Facility | | $25,449.54 | $25,449.54 | $25,449.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,210.34 / $25,449.54 / $25,449.54
| Professional | | $20,210.34 | $25,449.54 | $25,449.54 |
- 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
- $33,452.65 / $44,275.57 / $49,195.08
| Professional | | $33,452.65 | $44,275.57 | $49,195.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,828.21 / $37,828.21 / $38,606.32
| Facility | | $37,828.21 | $37,828.21 | $38,606.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,828.21 / $37,828.21 / $37,828.21
| Professional | | $37,828.21 | $37,828.21 | $37,828.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,000.48 / $31,000.48 / $31,000.48
| Facility | | $31,000.48 | $31,000.48 | $31,000.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $31,019.05
| Professional | | $31,019.05 | $31,019.05 | $31,019.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,249.48 / $20,358.81 / $30,599.29
| Professional | | $13,249.48 | $20,358.81 | $30,599.29 |