- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,817.38 / $4,817.38 / $4,817.38
| Facility | | $4,817.38 | $4,817.38 | $4,817.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,783.88 / $4,817.38 / $4,817.38
| Professional | | $2,783.88 | $4,817.38 | $4,817.38 |
- 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
- $7,482.18 / $9,902.89 / $11,003.21
| Professional | | $7,482.18 | $9,902.89 | $11,003.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,500.36 / $6,500.36 / $7,354.35
| Facility | | $6,500.36 | $6,500.36 | $7,354.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,354.35 / $7,354.35 / $7,354.35
| Professional | | $7,354.35 | $7,354.35 | $7,354.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,423.18 / $4,423.18 / $6,933.72
| Facility | | $4,423.18 | $4,423.18 | $6,933.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,228.92 / $4,423.18 / $6,771.21
| Professional | | $3,228.92 | $4,423.18 | $6,771.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.96 / $4,285.38 / $5,210.72
| Professional | | $2,161.96 | $4,285.38 | $5,210.72 |