- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,011.81 / $2,011.81 / $2,011.81
| Facility | | $2,011.81 | $2,011.81 | $2,011.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.25 / $2,011.81 / $2,011.81
| Professional | | $1,500.25 | $2,011.81 | $2,011.81 |
- 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
- $3,124.67 / $4,135.60 / $4,595.10
| Professional | | $3,124.67 | $4,135.60 | $4,595.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,503.09 / $3,503.09 / $3,864.06
| Facility | | $3,503.09 | $3,503.09 | $3,864.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,864.06 / $3,864.06 / $3,864.06
| Professional | | $3,864.06 | $3,864.06 | $3,864.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,782.58 / $2,782.58 / $2,895.62
| Facility | | $2,782.58 | $2,782.58 | $2,895.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.28 / $2,031.28 / $2,782.58
| Professional | | $2,031.28 | $2,031.28 | $2,782.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.32 / $1,805.74 / $2,605.67
| Professional | | $1,128.32 | $1,805.74 | $2,605.67 |