- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,354.50 / $1,354.50 / $1,354.50
| Facility | | $1,354.50 | $1,354.50 | $1,354.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.50 / $1,523.20 / $2,485.75
| Professional | | $1,354.50 | $1,523.20 | $2,485.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,147.78 / $17,908.96 / $36,581.76
| Facility | | $7,147.78 | $17,908.96 | $36,581.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.96 / $4,413.43 / $5,352.86
| Professional | | $2,596.96 | $4,413.43 | $5,352.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,148.44 / $4,913.91 / $11,821.06
| Facility | | $3,148.44 | $4,913.91 | $11,821.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,496.52 / $4,463.29 / $6,131.12
| Professional | | $2,496.52 | $4,463.29 | $6,131.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.40 / $4,484.26 / $9,307.93
| Facility | | $2,728.40 | $4,484.26 | $9,307.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,471.81 / $4,068.46 / $5,605.65
| Professional | | $2,471.81 | $4,068.46 | $5,605.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.76 / $2,473.94 / $4,275.39
| Facility | | $1,454.76 | $2,473.94 | $4,275.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.48 / $3,330.41 / $10,984.16
| Professional | | $1,780.48 | $3,330.41 | $10,984.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $2,260.00 / $5,379.86
| Facility | | $796.00 | $2,260.00 | $5,379.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.61 / $3,174.11 / $6,067.15
| Professional | | $1,700.61 | $3,174.11 | $6,067.15 |