- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.07 / $1,857.07 / $1,857.07
| Facility | | $1,857.07 | $1,857.07 | $1,857.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.07 / $2,005.64 / $6,644.70
| Professional | | $1,857.07 | $2,005.64 | $6,644.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.68 / $2,175.79 / $4,053.58
| Facility | | $339.68 | $2,175.79 | $4,053.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.67 / $1,753.34 / $1,753.34
| Professional | | $1,402.67 | $1,753.34 | $1,753.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,369.91 / $5,799.10 / $7,060.04
| Facility | | $3,369.91 | $5,799.10 | $7,060.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,838.87 / $2,189.65 / $2,312.23
| Professional | | $1,838.87 | $2,189.65 | $2,312.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.75 / $5,292.06 / $6,641.78
| Facility | | $2,906.75 | $5,292.06 | $6,641.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.66 / $1,820.66 / $2,548.92
| Professional | | $1,820.66 | $1,820.66 | $2,548.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.87 / $719.87 / $3,138.45
| Facility | | $719.87 | $719.87 | $3,138.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.65 / $2,062.81 / $2,454.69
| Professional | | $2,036.65 | $2,062.81 | $2,454.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.04 / $2,062.81 / $2,490.37
| Professional | | $1,969.04 | $2,062.81 | $2,490.37 |