- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.32 / $4,292.34 / $8,800.79
| Facility | | $1,730.32 | $4,292.34 | $8,800.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,799.54 / $3,707.35
| Professional | | $1,730.32 | $1,799.54 | $3,707.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $1,477.55 / $5,644.30
| Facility | | $941.10 | $1,477.55 | $5,644.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,831.33 / $2,188.86
| Professional | | $1,730.32 | $1,831.33 | $2,188.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,856.63 / $2,207.89 / $4,706.47
| Facility | | $1,856.63 | $2,207.89 | $4,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,730.32
| Facility | | $1,730.32 | $1,730.32 | $1,730.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,730.32
| Professional | | $1,730.32 | $1,730.32 | $1,730.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.32 / $2,609.98 / $8,090.00
| Facility | | $1,730.32 | $2,609.98 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $3,593.53
| Professional | | $1,730.32 | $1,730.32 | $3,593.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,024.10 / $2,925.28 / $32,010.00
| Facility | | $2,024.10 | $2,925.28 | $32,010.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,301.66 / $2,301.66 / $8,651.60
| Facility | | $2,301.66 | $2,301.66 | $8,651.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,834.14 / $2,595.48
| Professional | | $1,730.32 | $1,834.14 | $2,595.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.04 / $1,718.39 / $2,346.35
| Facility | | $599.04 | $1,718.39 | $2,346.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,834.14 / $2,595.48
| Professional | | $1,730.32 | $1,834.14 | $2,595.48 |