- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.79 / $2,056.79 / $2,056.79
| Facility | | $2,056.79 | $2,056.79 | $2,056.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,593.46 / $2,056.79 / $2,056.79
| Professional | | $1,593.46 | $2,056.79 | $2,056.79 |
- 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
- $3,194.53 / $4,228.06 / $4,697.84
| Professional | | $3,194.53 | $4,228.06 | $4,697.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,700.45 / $3,700.45 / $3,720.76
| Facility | | $3,700.45 | $3,700.45 | $3,720.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,700.45 / $3,700.45 / $3,700.45
| Professional | | $3,700.45 | $3,700.45 | $3,700.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,717.61 / $2,717.61 / $2,960.36
| Facility | | $2,717.61 | $2,717.61 | $2,960.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.86 / $2,717.61 / $2,890.98
| Professional | | $1,983.86 | $2,717.61 | $2,890.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.74 / $1,846.11 / $2,844.80
| Professional | | $1,230.74 | $1,846.11 | $2,844.80 |