- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.24 / $1,471.24 / $3,073.00
| Facility | | $1,471.24 | $1,471.24 | $3,073.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.00 / $1,471.24 / $1,471.24
| Professional | | $1,467.00 | $1,471.24 | $1,471.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.81 / $2,479.23 / $2,714.00
| Facility | | $2,097.81 | $2,479.23 | $2,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.13 / $3,167.70 / $8,620.34
| Professional | | $1,870.13 | $3,167.70 | $8,620.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.50 / $3,079.81 / $6,077.06
| Facility | | $1,764.50 | $3,079.81 | $6,077.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,779.18 / $7,779.18 / $7,779.18
| Professional | | $7,779.18 | $7,779.18 | $7,779.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.00 / $2,714.00 / $2,714.00
| Facility | | $2,714.00 | $2,714.00 | $2,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.13 / $3,129.02 / $4,446.68
| Professional | | $1,870.13 | $3,129.02 | $4,446.68 |