- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $3,684.00 / $18,600.00
| Facility | | $1,300.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.21 / $1,543.93 / $1,850.43
| Professional | | $1,328.21 | $1,543.93 | $1,850.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.65 / $1,906.62 / $2,443.53
| Professional | | $1,404.65 | $1,906.62 | $2,443.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.32 / $1,850.45 / $5,415.32
| Facility | | $1,310.32 | $1,850.45 | $5,415.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.55 / $1,772.04 / $10,307.12
| Professional | | $1,310.55 | $1,772.04 | $10,307.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.09 / $1,657.02 / $2,486.50
| Professional | | $1,205.09 | $1,657.02 | $2,486.50 |