- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,028.62 / $27,028.62 / $27,028.62
| Facility | | $27,028.62 | $27,028.62 | $27,028.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,545.34 / $27,028.62 / $27,028.62
| Professional | | $20,545.34 | $27,028.62 | $27,028.62 |
- 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
- $41,979.87 / $55,561.59 / $61,735.10
| Professional | | $41,979.87 | $55,561.59 | $61,735.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,211.27 / $47,211.27 / $48,632.79
| Facility | | $47,211.27 | $47,211.27 | $48,632.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,211.27 / $47,211.27 / $47,211.27
| Professional | | $47,211.27 | $47,211.27 | $47,211.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $38,902.61
| Facility | | $31,290.51 | $31,290.51 | $38,902.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $31,290.51 / $37,990.83
| Professional | | $22,842.07 | $31,290.51 | $37,990.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,371.62 / $24,260.11 / $32,492.07
| Professional | | $14,371.62 | $24,260.11 | $32,492.07 |