- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.56 / $1,578.56 / $1,578.56
| Facility | | $1,578.56 | $1,578.56 | $1,578.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.56 / $1,854.06 / $2,322.46
| Professional | | $1,578.56 | $1,854.06 | $2,322.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,981.61 / $18,757.52 / $40,101.86
| Facility | | $8,981.61 | $18,757.52 | $40,101.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,423.71 / $3,629.19 / $5,591.68
| Professional | | $2,423.71 | $3,629.19 | $5,591.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,487.82 / $4,946.16 / $11,898.65
| Facility | | $3,487.82 | $4,946.16 | $11,898.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,829.33 / $4,604.72 / $6,678.00
| Professional | | $2,829.33 | $4,604.72 | $6,678.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,835.34 / $4,521.97 / $9,369.01
| Facility | | $2,835.34 | $4,521.97 | $9,369.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,364.42 / $3,794.91 / $5,649.08
| Professional | | $2,364.42 | $3,794.91 | $5,649.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $2,894.52 / $4,308.13
| Facility | | $2,097.00 | $2,894.52 | $4,308.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.54 / $3,527.26 / $6,571.21
| Professional | | $2,188.54 | $3,527.26 | $6,571.21 |
- 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
- $2,063.56 / $3,601.49 / $6,242.73
| Professional | | $2,063.56 | $3,601.49 | $6,242.73 |