- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.93 / $1,395.93 / $1,395.93
| Facility | | $1,395.93 | $1,395.93 | $1,395.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.93 / $1,395.93 / $2,022.52
| Professional | | $1,395.93 | $1,395.93 | $2,022.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.98 / $6,299.49 / $12,568.75
| Facility | | $2,652.98 | $6,299.49 | $12,568.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,392.66 / $3,697.91 / $5,188.62
| Professional | | $2,392.66 | $3,697.91 | $5,188.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,241.03 / $4,596.18 / $11,056.75
| Facility | | $3,241.03 | $4,596.18 | $11,056.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,629.47 / $4,431.30 / $6,308.45
| Professional | | $2,629.47 | $4,431.30 | $6,308.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,634.73 / $4,202.02 / $8,706.10
| Facility | | $2,634.73 | $4,202.02 | $8,706.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,315.00 / $3,961.65 / $5,250.04
| Professional | | $2,315.00 | $3,961.65 | $5,250.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.41 / $2,359.12 / $3,701.89
| Facility | | $1,949.41 | $2,359.12 | $3,701.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.98 / $3,580.38 / $7,699.05
| Professional | | $1,908.98 | $3,580.38 | $7,699.05 |
- 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
- $1,914.81 / $4,369.60 / $6,341.04
| Professional | | $1,914.81 | $4,369.60 | $6,341.04 |