- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,556.00 / $7,370.00 / $19,950.00
| Facility | | $4,556.00 | $7,370.00 | $19,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,325.00 / $4,150.00 / $4,250.00
| Professional | | $3,325.00 | $4,150.00 | $4,250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.48 / $8,698.61 / $13,779.81
| Facility | | $2,290.48 | $8,698.61 | $13,779.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,896.03 / $4,212.39 / $20,403.81
| Professional | | $2,896.03 | $4,212.39 | $20,403.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,339.94 / $8,125.00 / $14,625.00
| Facility | | $3,339.94 | $8,125.00 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.00 / $5,000.00 / $9,128.45
| Facility | | $3,350.00 | $5,000.00 | $9,128.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $24,900.00
| Professional | | $2,100.00 | $2,100.00 | $24,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $3,000.00
| Professional | | $2,100.00 | $2,100.00 | $3,000.00 |