- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.10 / $2,242.50 / $6,475.95
| Facility | | $1,439.10 | $2,242.50 | $6,475.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.00 / $1,439.10 / $1,509.30
| Professional | | $1,326.00 | $1,439.10 | $1,509.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.50 / $1,755.00 / $5,850.00
| Facility | | $1,540.50 | $1,755.00 | $5,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.35 / $1,549.20 / $2,087.08
| Professional | | $1,239.35 | $1,549.20 | $2,087.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $2,535.00 / $3,120.00
| Facility | | $1,950.00 | $2,535.00 | $3,120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.00 / $2,340.00 / $2,925.00
| Professional | | $1,950.00 | $2,340.00 | $2,925.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.50 / $1,755.00 / $4,346.13
| Facility | | $1,267.50 | $1,755.00 | $4,346.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.94 / $2,240.53 / $2,845.47
| Professional | | $2,044.94 | $2,240.53 | $2,845.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,755.00 / $2,340.00
| Facility | | $1,755.00 | $1,755.00 | $2,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $1,053.00 / $1,928.75
| Professional | | $737.10 | $1,053.00 | $1,928.75 |