- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,180.83 / $3,180.83 / $3,180.83
| Facility | | $3,180.83 | $3,180.83 | $3,180.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,261.06 / $3,180.83 / $3,180.83
| Professional | | $2,261.06 | $3,180.83 | $3,180.83 |
- 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
- $4,940.35 / $6,538.70 / $7,265.22
| Professional | | $4,940.35 | $6,538.70 | $7,265.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,460.46 / $5,460.46 / $5,517.45
| Facility | | $5,460.46 | $5,460.46 | $5,517.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,460.46 / $5,460.46 / $5,460.46
| Professional | | $5,460.46 | $5,460.46 | $5,460.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,728.42 / $3,728.42 / $4,578.21
| Facility | | $3,728.42 | $3,728.42 | $4,578.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,721.75 / $3,728.42 / $4,470.89
| Professional | | $2,721.75 | $3,728.42 | $4,470.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.34 / $2,855.02 / $4,064.11
| Professional | | $1,708.34 | $2,855.02 | $4,064.11 |