- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,943.28 / $10,000.00
| Professional | | $6,456.54 | $7,943.28 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $6,165.95
| Facility | | $5,128.61 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $4,365.16 / $5,128.61
| Professional | | $912.01 | $4,365.16 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $851.14 / $5,623.41
| Facility | | $302.00 | $851.14 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,890.45 / $8,317.64
| Professional | | $2,398.83 | $3,890.45 | $8,317.64 |