- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.34 / $1,025.34 / $1,529.39
| Facility | | $1,025.34 | $1,025.34 | $1,529.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.34 / $1,107.38 / $2,050.69
| Professional | | $1,025.34 | $1,107.38 | $2,050.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,341.96 / $2,341.96 / $2,341.96
| Facility | | $2,341.96 | $2,341.96 | $2,341.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $1,800.00 / $1,800.00
| Facility | | $1,800.00 | $1,800.00 | $1,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.00 / $1,530.00 / $1,800.00
| Professional | | $1,530.00 | $1,530.00 | $1,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,007.20 / $10,800.08 / $10,800.08
| Facility | | $10,007.20 | $10,800.08 | $10,800.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,751.80 / $11,751.80 / $17,052.75
| Professional | | $11,751.80 | $11,751.80 | $17,052.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.42 / $1,632.12 / $2,341.96
| Facility | | $670.42 | $1,632.12 | $2,341.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.42 / $2,154.60 / $2,341.96
| Professional | | $670.42 | $2,154.60 | $2,341.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.42 / $1,643.07 / $2,341.96
| Facility | | $670.42 | $1,643.07 | $2,341.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.00 / $1,530.00 / $1,854.00
| Professional | | $1,530.00 | $1,530.00 | $1,854.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.39 / $1,280.20 / $1,564.83
| Professional | | $865.39 | $1,280.20 | $1,564.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.20 / $1,259.58 / $2,341.96
| Professional | | $1,250.20 | $1,259.58 | $2,341.96 |