- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.28 / $67,425.05 / $135,246.73
| Facility | | $1,214.28 | $67,425.05 | $135,246.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.28 / $1,214.28 / $1,214.28
| Professional | | $1,214.28 | $1,214.28 | $1,214.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125,000.00 / $125,000.00 / $125,000.00
| Facility | | $125,000.00 | $125,000.00 | $125,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.54 / $1,243.54 / $1,243.54
| Professional | | $1,243.54 | $1,243.54 | $1,243.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,962.24 / $2,519.42 / $3,512.65
| Facility | | $1,962.24 | $2,519.42 | $3,512.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,219.16 / $1,219.16 / $1,219.16
| Professional | | $1,219.16 | $1,219.16 | $1,219.16 |