- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,543.11 / $5,543.11 / $14,181.25
| Facility | | $5,543.11 | $5,543.11 | $14,181.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,221.34 / $5,543.11 / $5,543.11
| Professional | | $4,221.34 | $5,543.11 | $5,543.11 |
- 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
- $8,609.34 / $11,394.72 / $12,660.80
| Professional | | $8,609.34 | $11,394.72 | $12,660.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,856.83 / $9,856.83 / $10,047.45
| Facility | | $9,856.83 | $9,856.83 | $10,047.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,047.45 / $10,047.45 / $10,047.45
| Professional | | $10,047.45 | $10,047.45 | $10,047.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,957.05 / $7,957.05 / $7,978.26
| Facility | | $7,957.05 | $7,957.05 | $7,978.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,995.71 / $7,791.26 / $7,957.05
| Professional | | $5,995.71 | $7,791.26 | $7,957.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,147.53 / $10,147.53 / $11,938.27
| Facility | | $10,147.53 | $10,147.53 | $11,938.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,977.94 / $4,975.33 / $6,883.36
| Professional | | $2,977.94 | $4,975.33 | $6,883.36 |