- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,936.68 / $1,936.68 / $1,936.68
| Facility | | $1,936.68 | $1,936.68 | $1,936.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.68 / $1,936.68 / $2,891.95
| Professional | | $1,936.68 | $1,936.68 | $2,891.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $10,272.64 / $18,656.93
| Facility | | $4,142.55 | $10,272.64 | $18,656.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,668.44 / $5,664.46 / $7,947.93
| Professional | | $3,668.44 | $5,664.46 | $7,947.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,772.27 / $6,767.67 / $16,280.54
| Facility | | $4,772.27 | $6,767.67 | $16,280.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,879.62 / $6,524.88 / $9,307.74
| Professional | | $3,879.62 | $6,524.88 | $9,307.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,879.51 / $6,187.27 / $12,819.33
| Facility | | $3,879.51 | $6,187.27 | $12,819.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,415.64 / $5,845.18 / $7,746.11
| Professional | | $3,415.64 | $5,845.18 | $7,746.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.59 / $3,415.21 / $4,684.80
| Facility | | $2,392.59 | $3,415.21 | $4,684.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,746.86 / $5,161.71 / $11,561.62
| Professional | | $2,746.86 | $5,161.71 | $11,561.62 |
- 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
- $2,846.21 / $5,184.09 / $8,649.49
| Professional | | $2,846.21 | $5,184.09 | $8,649.49 |