- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $2,310.00 / $2,474.46
| Facility | | $2,310.00 | $2,310.00 | $2,474.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,310.00 / $2,310.00 / $2,310.00
| Professional | | $2,310.00 | $2,310.00 | $2,310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.01 / $1,538.88 / $2,976.70
| Facility | | $1,170.01 | $1,538.88 | $2,976.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,054.00 / $5,565.00 / $5,740.00
| Professional | | $5,054.00 | $5,565.00 | $5,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,200.00 / $6,356.97 / $7,946.21
| Professional | | $4,200.00 | $6,356.97 | $7,946.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,255.43 / $16,625.00
| Facility | | $2,100.00 | $5,255.43 | $16,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $10,115.00
| Professional | | $2,100.00 | $2,100.00 | $10,115.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $6,793.50 / $9,879.50
| Facility | | $4,200.00 | $6,793.50 | $9,879.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,200.00 / $6,862.28 / $8,960.00
| Professional | | $4,200.00 | $6,862.28 | $8,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,095.00 / $4,095.00 / $7,140.00
| Professional | | $4,095.00 | $4,095.00 | $7,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.00 / $2,100.00 / $6,825.00
| Professional | | $1,995.00 | $2,100.00 | $6,825.00 |