- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.48 / $1,490.48 / $1,490.48
| Facility | | $1,490.48 | $1,490.48 | $1,490.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.05 / $1,490.48 / $1,996.67
| Professional | | $1,460.05 | $1,490.48 | $1,996.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $8,679.34 / $14,441.72
| Facility | | $4,142.55 | $8,679.34 | $14,441.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,704.89 / $4,193.45 / $5,890.01
| Professional | | $2,704.89 | $4,193.45 | $5,890.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,618.37 / $5,131.29 / $12,344.02
| Facility | | $3,618.37 | $5,131.29 | $12,344.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,925.86 / $4,947.21 / $7,019.54
| Professional | | $2,925.86 | $4,947.21 | $7,019.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.47 / $4,691.22 / $9,719.70
| Facility | | $2,941.47 | $4,691.22 | $9,719.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.94 / $4,408.21 / $5,841.82
| Professional | | $2,575.94 | $4,408.21 | $5,841.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.41 / $2,593.21 / $4,301.28
| Facility | | $1,832.41 | $2,593.21 | $4,301.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,461.36 / $4,080.79 / $9,140.48
| Professional | | $2,461.36 | $4,080.79 | $9,140.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,139.23 / $3,785.66 / $6,523.03
| Professional | | $2,139.23 | $3,785.66 | $6,523.03 |