- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,719.64 / $6,719.64 / $6,719.64
| Facility | | $6,719.64 | $6,719.64 | $6,719.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,967.86 / $6,719.64 / $6,719.64
| Professional | | $3,967.86 | $6,719.64 | $6,719.64 |
- 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
- $10,436.70 / $13,813.28 / $15,348.09
| Professional | | $10,436.70 | $13,813.28 | $15,348.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,264.95 / $9,264.95 / $9,381.12
| Facility | | $9,264.95 | $9,264.95 | $9,381.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,381.12 / $9,381.12 / $9,381.12
| Professional | | $9,381.12 | $9,381.12 | $9,381.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,553.03 / $6,553.03 / $9,671.66
| Facility | | $6,553.03 | $6,553.03 | $9,671.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,783.71 / $6,553.03 / $9,444.98
| Professional | | $4,783.71 | $6,553.03 | $9,444.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,015.68 / $5,762.46 / $7,253.74
| Professional | | $3,015.68 | $5,762.46 | $7,253.74 |