- 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
- $1,613.65 / $1,736.82 / $1,736.82
| Professional | | $1,613.65 | $1,736.82 | $1,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,367.47 / $3,570.62 / $4,463.27
| Professional | | $3,367.47 | $3,570.62 | $4,463.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,727.07 / $4,712.52
| Facility | | $2,000.00 | $2,727.07 | $4,712.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.23 / $3,424.54 / $12,378.16
| Professional | | $1,889.23 | $3,424.54 | $12,378.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,354.00 / $4,106.21 / $5,382.07
| Facility | | $3,354.00 | $4,106.21 | $5,382.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,069.00 / $3,762.70 / $4,663.76
| Professional | | $3,069.00 | $3,762.70 | $4,663.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,196.94 / $2,933.46 / $3,344.47
| Professional | | $2,196.94 | $2,933.46 | $3,344.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.23 / $3,435.28 / $4,634.53
| Professional | | $1,889.23 | $3,435.28 | $4,634.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,449.70 / $4,058.50 / $4,220.80
| Professional | | $3,449.70 | $4,058.50 | $4,220.80 |