- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,903.87 / $2,903.87 / $2,903.87
| Facility | | $2,903.87 | $2,903.87 | $2,903.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,237.65 / $2,903.87 / $2,903.87
| Professional | | $2,237.65 | $2,903.87 | $2,903.87 |
- 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
- $4,510.18 / $5,969.37 / $6,632.63
| Professional | | $4,510.18 | $5,969.37 | $6,632.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.89 / $5,224.89 / $5,406.56
| Facility | | $5,224.89 | $5,224.89 | $5,406.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,406.56 / $5,406.56 / $5,406.56
| Professional | | $5,406.56 | $5,406.56 | $5,406.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,745.37 / $3,745.37 / $4,179.58
| Facility | | $3,745.37 | $3,745.37 | $4,179.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.12 / $2,734.12 / $3,926.21
| Professional | | $2,734.12 | $2,734.12 | $3,926.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.35 / $2,606.42 / $4,008.86
| Professional | | $1,734.35 | $2,606.42 | $4,008.86 |