- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,090.30 / $9,772.37
| Facility | | $1,000.00 | $3,090.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,709.64 / $13,489.63
| Facility | | $3,981.07 | $8,709.64 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $588.84
| Facility | | $398.11 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $2,951.21 / $5,011.87
| Professional | | $851.14 | $2,951.21 | $5,011.87 |
- 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
- $1,096.48 / $4,168.69 / $7,585.78
| Facility | | $1,096.48 | $4,168.69 | $7,585.78 |