- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $1,949.84
| Facility | | $1,000.00 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $1,949.84
| Professional | | $1,000.00 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,202.26 / $3,019.95
| Facility | | $954.99 | $1,202.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $3,235.94
| Professional | | $933.25 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $9,549.93
| Facility | | $1,819.70 | $1,819.70 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $3,388.44
| Professional | | $1,513.56 | $1,513.56 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,445.44 / $1,584.89
| Facility | | $794.33 | $1,445.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,174.90 / $1,778.28
| Professional | | $870.96 | $1,174.90 | $1,778.28 |