- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.82 / $1,456.82 / $1,456.82
| Facility | | $1,456.82 | $1,456.82 | $1,456.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.58 / $1,553.81 / $2,457.09
| Professional | | $1,419.58 | $1,553.81 | $2,457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,420.29 / $32,422.94 / $66,228.75
| Facility | | $7,420.29 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,815.85 / $4,530.92 / $5,759.73
| Professional | | $2,815.85 | $4,530.92 | $5,759.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,596.30 / $5,102.63 / $12,275.06
| Facility | | $3,596.30 | $5,102.63 | $12,275.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,692.59 / $4,289.22 / $6,370.17
| Professional | | $2,692.59 | $4,289.22 | $6,370.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,269.36 / $4,665.02 / $9,665.40
| Facility | | $3,269.36 | $4,665.02 | $9,665.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.79 / $3,836.36 / $5,841.82
| Professional | | $2,437.79 | $3,836.36 | $5,841.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.27 / $2,506.34 / $4,037.99
| Facility | | $1,601.27 | $2,506.34 | $4,037.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.58 / $3,033.78 / $6,252.20
| Professional | | $1,706.58 | $3,033.78 | $6,252.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.11 / $2,920.34 / $5,926.39
| Professional | | $1,709.11 | $2,920.34 | $5,926.39 |