- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $3,722.26
| Facility | | $1,828.72 | $1,828.72 | $3,722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $7,974.62
| Professional | | $1,828.72 | $1,828.72 | $7,974.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,014.17 / $2,616.07 / $6,414.39
| Facility | | $2,014.17 | $2,616.07 | $6,414.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.90 / $1,861.13 / $1,949.92
| Professional | | $1,488.90 | $1,861.13 | $1,949.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,323.54 / $5,719.31 / $6,962.90
| Facility | | $3,323.54 | $5,719.31 | $6,962.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.83 / $2,106.85 / $2,271.94
| Professional | | $1,806.83 | $2,106.85 | $2,271.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.76 / $5,219.25 / $6,550.39
| Facility | | $2,866.76 | $5,219.25 | $6,550.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,788.94 / $1,788.94 / $2,432.96
| Professional | | $1,788.94 | $1,788.94 | $2,432.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.13 / $1,861.13 / $3,145.31
| Facility | | $1,861.13 | $1,861.13 | $3,145.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,861.13 / $1,861.13 / $3,350.03
| Professional | | $1,861.13 | $1,861.13 | $3,350.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $3,291.70
| Professional | | $1,828.72 | $1,828.72 | $3,291.70 |