- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,137.50 / $6,562.50 / $13,627.95
| Facility | | $4,137.50 | $6,562.50 | $13,627.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $4,150.00 / $5,000.00
| Professional | | $3,500.00 | $4,150.00 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.19 / $7,337.50 / $19,500.00
| Facility | | $2,163.19 | $7,337.50 | $19,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,100.00 / $5,000.00
| Professional | | $2,000.00 | $2,100.00 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.12 / $6,769.75 / $14,816.43
| Facility | | $4,168.12 | $6,769.75 | $14,816.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,089.96 / $6,089.96 / $7,296.46
| Professional | | $6,089.96 | $6,089.96 | $7,296.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $5,000.00 / $7,500.00
| Facility | | $5,000.00 | $5,000.00 | $7,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $3,000.00 / $6,010.50
| Professional | | $2,100.00 | $3,000.00 | $6,010.50 |