- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,495.41 / $10,000.00
| Facility | | $1,000.00 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,290.87
| Facility | | $1,513.56 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $1,148.15
| Professional | | $794.33 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,445.44
| Professional | | $1,174.90 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,659.59
| Facility | | $794.33 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $5,011.87
| Facility | | $794.33 | $1,174.90 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |