- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,511.89 / $5,888.44
| Facility | | $1,000.00 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,495.41 / $18,620.87
| Facility | | $4,570.88 | $5,495.41 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $4,168.69
| Professional | | $977.24 | $1,548.82 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,365.16 / $9,332.54
| Facility | | $1,862.09 | $4,365.16 | $9,332.54 |