- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $9,332.54
| Facility | | $1,000.00 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $11,748.98
| Facility | | $2,884.03 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,918.31 / $7,413.10
| Facility | | $3,890.45 | $6,918.31 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $2,344.23
| Professional | | $537.03 | $891.25 | $2,344.23 |
- 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
- $1,698.24 / $4,365.16 / $9,332.54
| Facility | | $1,698.24 | $4,365.16 | $9,332.54 |