- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.33 / $1,480.05 / $4,749.03
| Facility | | $1,055.33 | $1,480.05 | $4,749.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.73 / $1,055.33 / $1,287.00
| Professional | | $1,016.73 | $1,055.33 | $1,287.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.73 / $1,151.86 / $3,861.00
| Facility | | $1,016.73 | $1,151.86 | $3,861.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $514.79 / $800.00
| Professional | | $100.00 | $514.79 | $800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,544.40 / $1,801.80
| Facility | | $1,287.00 | $1,544.40 | $1,801.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,480.05 / $1,866.15
| Professional | | $1,287.00 | $1,480.05 | $1,866.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.55 / $1,287.00 / $2,994.10
| Facility | | $836.55 | $1,287.00 | $2,994.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.54 / $1,478.95 / $1,848.69
| Professional | | $679.54 | $1,478.95 | $1,848.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.54 / $772.20 / $1,287.00
| Professional | | $540.54 | $772.20 | $1,287.00 |