- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,746.74 / $1,746.74 / $1,746.74
| Facility | | $1,746.74 | $1,746.74 | $1,746.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.66 / $1,746.74 / $1,746.74
| Professional | | $1,330.66 | $1,746.74 | $1,746.74 |
- 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
- $2,712.98 / $3,590.70 / $3,989.67
| Professional | | $2,712.98 | $3,590.70 | $3,989.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,107.08 / $3,107.08 / $3,107.08
| Facility | | $3,107.08 | $3,107.08 | $3,107.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.08 / $3,107.08 / $3,107.08
| Professional | | $3,107.08 | $3,107.08 | $3,107.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,479.82 / $2,479.82 / $2,514.11
| Facility | | $2,479.82 | $2,479.82 | $2,514.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.27 / $2,455.17 / $2,479.82
| Professional | | $1,810.27 | $2,455.17 | $2,479.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.39 / $1,567.82 / $2,388.64
| Professional | | $1,033.39 | $1,567.82 | $2,388.64 |