- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,616.29 / $2,616.29 / $2,616.29
| Facility | | $2,616.29 | $2,616.29 | $2,616.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.85 / $2,616.29 / $2,616.29
| Professional | | $1,905.85 | $2,616.29 | $2,616.29 |
- 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
- $4,063.54 / $5,378.21 / $5,975.79
| Professional | | $4,063.54 | $5,378.21 | $5,975.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,450.14 / $4,450.14 / $4,450.14
| Facility | | $4,450.14 | $4,450.14 | $4,450.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,450.14 / $4,450.14 / $4,450.14
| Professional | | $4,450.14 | $4,450.14 | $4,450.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,780.72 / $2,780.72 / $3,765.66
| Facility | | $2,780.72 | $2,780.72 | $3,765.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.93 / $2,780.72 / $3,677.41
| Professional | | $2,029.93 | $2,780.72 | $3,677.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.54 / $2,243.61 / $3,400.77
| Professional | | $1,565.54 | $2,243.61 | $3,400.77 |