- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.43 / $1,025.46 / $1,076.75
| Facility | | $388.43 | $1,025.46 | $1,076.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,999.35 / $64,999.35 / $64,999.35
| Professional | | $64,999.35 | $64,999.35 | $64,999.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.37 / $975.08 / $1,692.36
| Facility | | $472.37 | $975.08 | $1,692.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $55,249.45 / $55,249.45
| Professional | | $55,249.45 | $55,249.45 | $55,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.43 / $1,025.46 / $1,025.46
| Facility | | $388.43 | $1,025.46 | $1,025.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.88 / $963.41 / $1,645.13
| Facility | | $463.88 | $963.41 | $1,645.13 |