- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.06 / $1,361.06 / $1,361.06
| Facility | | $1,361.06 | $1,361.06 | $1,361.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.06 / $1,361.06 / $2,018.66
| Professional | | $1,361.06 | $1,361.06 | $2,018.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,322.53 / $13,104.74
| Facility | | $4,184.29 | $8,322.53 | $13,104.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,543.48 / $3,944.38 / $5,534.45
| Professional | | $2,543.48 | $3,944.38 | $5,534.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,362.32 / $4,768.18 / $11,470.51
| Facility | | $3,362.32 | $4,768.18 | $11,470.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.20 / $4,597.13 / $6,564.51
| Professional | | $2,736.20 | $4,597.13 | $6,564.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,733.32 / $4,359.26 / $9,031.90
| Facility | | $2,733.32 | $4,359.26 | $9,031.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,408.96 / $4,122.45 / $5,463.13
| Professional | | $2,408.96 | $4,122.45 | $5,463.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.68 / $2,424.89 / $3,500.00
| Facility | | $1,592.68 | $2,424.89 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.51 / $3,584.50 / $8,028.85
| Professional | | $1,697.51 | $3,584.50 | $8,028.85 |
- 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
- $1,757.76 / $3,744.03 / $5,956.71
| Professional | | $1,757.76 | $3,744.03 | $5,956.71 |