- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.35 / $2,155.35 / $3,188.87
| Facility | | $1,323.35 | $2,155.35 | $3,188.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,336.58 / $1,665.92
| Professional | | $1,323.35 | $1,336.58 | $1,665.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.56 / $1,455.56 / $1,455.56
| Professional | | $1,455.56 | $1,455.56 | $1,455.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $1,303.33
| Facility | | $80.00 | $80.00 | $1,303.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.44 / $1,323.35 / $1,444.55
| Facility | | $1,248.44 | $1,323.35 | $1,444.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,323.35 / $1,373.28
| Professional | | $1,323.35 | $1,323.35 | $1,373.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.30 / $7,015.85 / $7,222.75
| Facility | | $1,760.30 | $7,015.85 | $7,222.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,148.12 / $6,148.12 / $6,148.12
| Professional | | $6,148.12 | $6,148.12 | $6,148.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.41 / $1,376.79 / $1,985.03
| Facility | | $506.41 | $1,376.79 | $1,985.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,349.82 / $2,183.53
| Professional | | $1,323.35 | $1,349.82 | $2,183.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.33 / $1,521.85 / $2,727.01
| Professional | | $1,303.33 | $1,521.85 | $2,727.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.40 / $1,323.35 / $1,985.03
| Facility | | $512.40 | $1,323.35 | $1,985.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,323.35 / $1,783.31
| Professional | | $1,323.35 | $1,323.35 | $1,783.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,402.75 / $1,473.17
| Professional | | $1,323.35 | $1,402.75 | $1,473.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,392.52 / $1,852.69
| Professional | | $1,323.35 | $1,392.52 | $1,852.69 |