- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,780.18 / $2,780.18 / $2,780.18
| Facility | | $2,780.18 | $2,780.18 | $2,780.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,955.43 / $2,780.18 / $2,780.18
| Professional | | $1,955.43 | $2,780.18 | $2,780.18 |
- 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
- $4,318.07 / $5,715.10 / $6,350.11
| Professional | | $4,318.07 | $5,715.10 | $6,350.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.92 / $4,565.92 / $4,565.92
| Facility | | $4,565.92 | $4,565.92 | $4,565.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,565.92 / $4,565.92 / $4,565.92
| Professional | | $4,565.92 | $4,565.92 | $4,565.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,853.06 / $2,853.06 / $4,001.54
| Facility | | $2,853.06 | $2,853.06 | $4,001.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.73 / $2,853.06 / $3,907.76
| Professional | | $2,082.73 | $2,853.06 | $3,907.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.59 / $2,495.41 / $3,510.16
| Professional | | $1,518.59 | $2,495.41 | $3,510.16 |