- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,000.00 / $43,519.80 / $56,226.31
| Facility | | $30,000.00 | $43,519.80 | $56,226.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $345.40
| Professional | | $100.00 | $200.00 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,500.00 / $2,500.00
| Professional | | $1,500.00 | $2,500.00 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.42 / $468.31 / $757.22
| Professional | | $327.42 | $468.31 | $757.22 |