- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,452.40 / $4,995.47 / $16,346.40
| Facility | | $3,452.40 | $4,995.47 | $16,346.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,500.00 / $1,500.00
| Professional | | $1,500.00 | $1,500.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,142.59 / $5,368.64 / $7,546.35
| Facility | | $3,142.59 | $5,368.64 | $7,546.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,002.09 / $3,002.09 / $3,002.09
| Facility | | $3,002.09 | $3,002.09 | $3,002.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,141.38 / $5,759.42 / $21,202.85
| Facility | | $3,141.38 | $5,759.42 | $21,202.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,801.25 / $4,202.93
| Professional | | $1,260.88 | $1,801.25 | $4,202.93 |