- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.82 / $1,736.82 / $1,736.82
| Facility | | $1,736.82 | $1,736.82 | $1,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.82 / $2,049.51 / $2,582.92
| Professional | | $1,736.82 | $2,049.51 | $2,582.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,391.21 / $7,291.09 / $14,532.06
| Facility | | $3,391.21 | $7,291.09 | $14,532.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,717.56 / $4,147.39 / $6,283.33
| Professional | | $2,717.56 | $4,147.39 | $6,283.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,844.09 / $5,451.40 / $13,114.08
| Facility | | $3,844.09 | $5,451.40 | $13,114.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,115.52 / $5,070.52 / $7,353.51
| Professional | | $3,115.52 | $5,070.52 | $7,353.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,124.97 / $4,983.89 / $10,326.04
| Facility | | $3,124.97 | $4,983.89 | $10,326.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,603.60 / $4,178.78 / $6,220.51
| Professional | | $2,603.60 | $4,178.78 | $6,220.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,504.11 / $3,053.00 / $4,743.39
| Facility | | $2,504.11 | $3,053.00 | $4,743.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,211.96 / $3,690.88 / $7,247.64
| Professional | | $2,211.96 | $3,690.88 | $7,247.64 |
- 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
- $2,284.46 / $3,649.49 / $6,927.51
| Professional | | $2,284.46 | $3,649.49 | $6,927.51 |