- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,915.08 / $1,915.08 / $1,915.08
| Facility | | $1,915.08 | $1,915.08 | $1,915.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.73 / $1,915.08 / $1,915.08
| Professional | | $1,455.73 | $1,915.08 | $1,915.08 |
- 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
- $2,974.44 / $3,936.76 / $4,374.18
| Professional | | $2,974.44 | $3,936.76 | $4,374.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,345.13 / $3,345.13 / $3,445.81
| Facility | | $3,345.13 | $3,345.13 | $3,445.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,345.13 / $3,345.13 / $3,345.13
| Professional | | $3,345.13 | $3,345.13 | $3,345.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,217.07 / $2,217.07 / $2,756.40
| Facility | | $2,217.07 | $2,217.07 | $2,756.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.46 / $2,217.07 / $2,691.80
| Professional | | $1,618.46 | $2,217.07 | $2,691.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.86 / $2,018.42 / $2,036.58
| Facility | | $1,176.86 | $2,018.42 | $2,036.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.95 / $1,718.92 / $2,353.73
| Professional | | $1,145.95 | $1,718.92 | $2,353.73 |