- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,123.00 / $17,925.00 / $25,614.00
| Facility | | $13,123.00 | $17,925.00 | $25,614.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,433.59 / $3,433.59 / $3,433.59
| Professional | | $3,433.59 | $3,433.59 | $3,433.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $58.40 / $70.00
| Professional | | $50.00 | $58.40 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303,210.84 / $303,210.84 / $303,210.84
| Facility | | $303,210.84 | $303,210.84 | $303,210.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.61 / $1,291.61 / $3,433.59
| Professional | | $1,291.61 | $1,291.61 | $3,433.59 |