- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,979.61 / $1,979.61 / $1,979.61
| Facility | | $1,979.61 | $1,979.61 | $1,979.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.13 / $1,979.61 / $2,952.04
| Professional | | $1,943.13 | $1,979.61 | $2,952.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,260.85 / $18,527.43
| Facility | | $4,184.29 | $10,260.85 | $18,527.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,742.30 / $5,779.88 / $8,109.88
| Professional | | $3,742.30 | $5,779.88 | $8,109.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,880.92 / $6,921.75 / $16,651.21
| Facility | | $4,880.92 | $6,921.75 | $16,651.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,967.31 / $6,673.44 / $9,518.12
| Professional | | $3,967.31 | $6,673.44 | $9,518.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,967.84 / $6,328.14 / $13,111.19
| Facility | | $3,967.84 | $6,328.14 | $13,111.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,492.85 / $5,977.30 / $7,921.20
| Professional | | $3,492.85 | $5,977.30 | $7,921.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.32 / $3,492.34 / $5,165.60
| Facility | | $2,600.32 | $3,492.34 | $5,165.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,825.68 / $5,261.88 / $11,786.00
| Professional | | $2,825.68 | $5,261.88 | $11,786.00 |
- 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
- $2,949.12 / $5,692.92 / $8,550.81
| Professional | | $2,949.12 | $5,692.92 | $8,550.81 |