- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.68 / $1,470.68 / $1,588.33
| Facility | | $1,470.68 | $1,470.68 | $1,588.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.08 / $1,588.33 / $2,941.36
| Professional | | $1,386.08 | $1,588.33 | $2,941.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.12 / $2,000.12 / $2,000.12
| Professional | | $2,000.12 | $2,000.12 | $2,000.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,359.12 / $3,359.12 / $3,359.12
| Facility | | $3,359.12 | $3,359.12 | $3,359.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.89 / $1,819.89 / $1,819.89
| Facility | | $1,819.89 | $1,819.89 | $1,819.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.52 / $1,328.52 / $1,819.89
| Professional | | $1,328.52 | $1,328.52 | $1,819.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,534.23 / $16,880.98 / $16,880.98
| Facility | | $15,534.23 | $16,880.98 | $16,880.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,222.38 / $19,222.38 / $29,124.83
| Professional | | $19,222.38 | $19,222.38 | $29,124.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.03 / $2,340.96 / $3,359.12
| Facility | | $938.03 | $2,340.96 | $3,359.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.62 / $3,023.21 / $3,883.31
| Professional | | $948.62 | $3,023.21 | $3,883.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.03 / $2,244.46 / $3,359.12
| Facility | | $938.03 | $2,244.46 | $3,359.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.52 / $1,328.52 / $1,940.10
| Professional | | $1,328.52 | $1,328.52 | $1,940.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.27 / $1,776.27 / $1,776.27
| Facility | | $1,776.27 | $1,776.27 | $1,776.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.83 / $1,791.23 / $2,227.94
| Professional | | $1,210.83 | $1,791.23 | $2,227.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,760.19 / $1,762.37 / $3,359.12
| Professional | | $1,760.19 | $1,762.37 | $3,359.12 |