- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,129.71 / $2,129.71 / $2,129.71
| Facility | | $2,129.71 | $2,129.71 | $2,129.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.12 / $2,129.71 / $2,129.71
| Professional | | $1,641.12 | $2,129.71 | $2,129.71 |
- 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
- $3,307.79 / $4,377.95 / $4,864.39
| Professional | | $3,307.79 | $4,377.95 | $4,864.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.97 / $3,719.97 / $3,832.00
| Facility | | $3,719.97 | $3,719.97 | $3,832.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,719.97 / $3,719.97 / $3,719.97
| Professional | | $3,719.97 | $3,719.97 | $3,719.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.07 / $2,381.07 / $3,065.31
| Facility | | $2,381.07 | $2,381.07 | $3,065.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.18 / $2,381.07 / $2,993.47
| Professional | | $1,738.18 | $2,381.07 | $2,993.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.68 / $1,911.56 / $2,656.41
| Professional | | $1,132.68 | $1,911.56 | $2,656.41 |