- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.21 / $1,482.21 / $1,482.21
| Facility | | $1,482.21 | $1,482.21 | $1,482.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.21 / $1,482.21 / $2,111.77
| Professional | | $1,482.21 | $1,482.21 | $2,111.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,563.94 / $12,011.68
| Facility | | $3,692.86 | $7,563.94 | $12,011.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.28 / $3,738.70 / $5,245.85
| Professional | | $2,417.28 | $3,738.70 | $5,245.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,446.54 / $4,887.63 / $11,757.85
| Facility | | $3,446.54 | $4,887.63 | $11,757.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,791.26 / $4,712.29 / $6,696.62
| Professional | | $2,791.26 | $4,712.29 | $6,696.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,801.79 / $4,468.46 / $9,258.15
| Facility | | $2,801.79 | $4,468.46 | $9,258.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,457.44 / $4,205.41 / $5,573.07
| Professional | | $2,457.44 | $4,205.41 | $5,573.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.63 / $2,504.92 / $3,568.89
| Facility | | $1,925.63 | $2,504.92 | $3,568.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.65 / $3,436.70 / $7,390.08
| Professional | | $1,835.65 | $3,436.70 | $7,390.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,886.49 / $3,451.60 / $5,549.58
| Professional | | $1,886.49 | $3,451.60 | $5,549.58 |