- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.73 / $2,346.73 / $2,346.73
| Facility | | $2,346.73 | $2,346.73 | $2,346.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.75 / $2,346.73 / $4,186.42
| Professional | | $1,443.75 | $2,346.73 | $4,186.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.36 / $6,830.64 / $12,890.36
| Facility | | $1,555.36 | $6,830.64 | $12,890.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,003.52 / $3,003.52 / $6,690.92
| Professional | | $3,003.52 | $3,003.52 | $6,690.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,716.54 / $7,361.30 / $17,708.61
| Facility | | $4,716.54 | $7,361.30 | $17,708.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,902.51 / $6,813.14 / $9,865.77
| Professional | | $3,902.51 | $6,813.14 | $9,865.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,087.30 / $6,717.67 / $13,943.79
| Facility | | $4,087.30 | $6,717.67 | $13,943.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,733.44 / $6,145.05 / $8,466.84
| Professional | | $3,733.44 | $6,145.05 | $8,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $3,632.13 / $6,053.55
| Facility | | $2,097.00 | $3,632.13 | $6,053.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.03 / $4,852.81 / $16,826.72
| Professional | | $2,405.03 | $4,852.81 | $16,826.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.46 / $4,333.71 / $9,032.51
| Professional | | $2,103.46 | $4,333.71 | $9,032.51 |