- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,102.38 / $8,102.38 / $8,102.38
| Facility | | $8,102.38 | $8,102.38 | $8,102.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,751.14 / $8,102.38 / $8,102.38
| Professional | | $4,751.14 | $8,102.38 | $8,102.38 |
- 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
- $12,584.32 / $16,655.72 / $18,506.36
| Professional | | $12,584.32 | $16,655.72 | $18,506.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,093.94 / $11,093.94 / $11,851.35
| Facility | | $11,093.94 | $11,093.94 | $11,851.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,851.35 / $11,851.35 / $11,851.35
| Professional | | $11,851.35 | $11,851.35 | $11,851.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,732.85 / $8,732.85 / $11,661.86
| Facility | | $8,732.85 | $8,732.85 | $11,661.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $8,732.85 / $11,388.53
| Professional | | $6,374.98 | $8,732.85 | $11,388.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.86 / $5,544.86 / $5,544.86
| Facility | | $5,544.86 | $5,544.86 | $5,544.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,689.76 / $7,120.71 / $8,746.39
| Professional | | $3,689.76 | $7,120.71 | $8,746.39 |