- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.43 / $1,473.43 / $1,473.43
| Facility | | $1,473.43 | $1,473.43 | $1,473.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.43 / $1,725.44 / $2,154.40
| Professional | | $1,473.43 | $1,725.44 | $2,154.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,801.68 / $6,023.62 / $12,100.51
| Facility | | $2,801.68 | $6,023.62 | $12,100.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.36 / $3,426.43 / $5,191.06
| Professional | | $2,252.36 | $3,426.43 | $5,191.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,260.40 / $4,623.66 / $11,122.83
| Facility | | $3,260.40 | $4,623.66 | $11,122.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,651.22 / $4,314.85 / $6,257.62
| Professional | | $2,651.22 | $4,314.85 | $6,257.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,650.47 / $4,227.13 / $8,758.14
| Facility | | $2,650.47 | $4,227.13 | $8,758.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.59 / $3,556.02 / $5,293.47
| Professional | | $2,215.59 | $3,556.02 | $5,293.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.15 / $2,712.18 / $3,954.00
| Facility | | $1,816.15 | $2,712.18 | $3,954.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,799.75 / $3,070.74 / $6,064.13
| Professional | | $1,799.75 | $3,070.74 | $6,064.13 |
- 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
- $1,887.34 / $3,625.46 / $5,829.12
| Professional | | $1,887.34 | $3,625.46 | $5,829.12 |