- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.13 / $1,653.13 / $1,653.13
| Facility | | $1,653.13 | $1,653.13 | $1,653.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.10 / $1,653.13 / $1,653.13
| Professional | | $1,223.10 | $1,653.13 | $1,653.13 |
- 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
- $2,567.58 / $3,398.27 / $3,775.86
| Professional | | $2,567.58 | $3,398.27 | $3,775.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,855.97 / $2,855.97 / $2,963.80
| Facility | | $2,855.97 | $2,855.97 | $2,963.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,963.80 / $2,963.80 / $2,963.80
| Professional | | $2,963.80 | $2,963.80 | $2,963.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.41 / $2,050.41 / $2,379.38
| Facility | | $2,050.41 | $2,050.41 | $2,379.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.80 / $1,496.80 / $2,235.14
| Professional | | $1,496.80 | $1,496.80 | $2,235.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.88 / $1,483.80 / $2,195.59
| Professional | | $949.88 | $1,483.80 | $2,195.59 |