- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,180.61 / $2,180.61 / $2,180.61
| Facility | | $2,180.61 | $2,180.61 | $2,180.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.74 / $2,180.61 / $2,180.61
| Professional | | $1,419.74 | $2,180.61 | $2,180.61 |
- 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
- $3,386.85 / $4,482.59 / $4,980.66
| Professional | | $3,386.85 | $4,482.59 | $4,980.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.08 / $3,315.08 / $3,315.08
| Facility | | $3,315.08 | $3,315.08 | $3,315.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,315.08 / $3,315.08 / $3,315.08
| Professional | | $3,315.08 | $3,315.08 | $3,315.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.76 / $2,637.76 / $3,138.58
| Facility | | $2,637.76 | $2,637.76 | $3,138.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.56 / $2,637.76 / $3,065.02
| Professional | | $1,925.56 | $2,637.76 | $3,065.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.83 / $1,957.26 / $2,623.01
| Professional | | $1,304.83 | $1,957.26 | $2,623.01 |