- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,905.46 / $3,890.45
| Facility | | $1,000.00 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,344.23
| Professional | | $1,047.13 | $1,288.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $3,162.28
| Facility | | $1,288.25 | $1,513.56 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,288.25 / $1,479.11
| Professional | | $1,148.15 | $1,288.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $2,344.23
| Facility | | $1,288.25 | $1,288.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,288.25 / $1,548.82
| Professional | | $1,202.26 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.20 / $501.19 / $2,398.83
| Facility | | $1.20 | $501.19 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,288.25 / $1,380.38
| Professional | | $512.86 | $1,288.25 | $1,380.38 |