- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.10 / $1,404.10 / $3,073.00
| Facility | | $1,404.10 | $1,404.10 | $3,073.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.64 / $1,404.10 / $1,404.10
| Professional | | $1,373.64 | $1,404.10 | $1,404.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.41 / $1,974.41 / $2,126.27
| Professional | | $1,974.41 | $1,974.41 | $2,126.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,964.31 / $2,321.44 / $2,372.92
| Facility | | $1,964.31 | $2,321.44 | $2,372.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,637.36 / $2,777.34 / $10,709.60
| Professional | | $1,637.36 | $2,777.34 | $10,709.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.91 / $2,171.21 / $2,686.49
| Facility | | $1,651.91 | $2,171.21 | $2,686.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.41 / $2,171.21 / $2,686.49
| Professional | | $1,974.41 | $2,171.21 | $2,686.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.40 / $2,777.34 / $3,898.94
| Professional | | $1,666.40 | $2,777.34 | $3,898.94 |