- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,250.03 / $27,250.03 / $27,250.03
| Facility | | $27,250.03 | $27,250.03 | $27,250.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,791.62 / $27,250.03 / $27,250.03
| Professional | | $16,791.62 | $27,250.03 | $27,250.03 |
- 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
- $42,323.76 / $56,016.75 / $62,240.83
| Professional | | $42,323.76 | $56,016.75 | $62,240.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,208.42 / $39,208.42 / $41,907.21
| Facility | | $39,208.42 | $39,208.42 | $41,907.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,907.21 / $41,907.21 / $41,907.21
| Professional | | $41,907.21 | $41,907.21 | $41,907.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $39,221.30
| Facility | | $30,391.12 | $30,391.12 | $39,221.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $38,302.05
| Professional | | $22,185.52 | $30,391.12 | $38,302.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,040.44 / $24,458.84 / $30,142.37
| Professional | | $13,040.44 | $24,458.84 | $30,142.37 |