- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,888.44 / $9,549.93
| Facility | | $1,445.44 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $1,412.54
| Professional | | $912.01 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $2,089.30
| Professional | | $1,412.54 | $1,621.81 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,187.76
| Facility | | $1,000.00 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,412.54 / $10,000.00
| Facility | | $954.99 | $1,412.54 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |