- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.06 / $1,771.06 / $1,771.06
| Facility | | $1,771.06 | $1,771.06 | $1,771.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.47 / $1,771.06 / $1,771.06
| Professional | | $938.47 | $1,771.06 | $1,771.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,811.31 / $2,114.46 / $2,944.32
| Facility | | $1,811.31 | $2,114.46 | $2,944.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.57 / $2,008.74 / $2,114.46
| Professional | | $1,691.57 | $2,008.74 | $2,114.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.82 / $6,523.87 / $18,119.50
| Facility | | $1,367.82 | $6,523.87 | $18,119.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.38 / $2,598.46 / $3,113.25
| Professional | | $2,451.38 | $2,598.46 | $3,113.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.15 / $6,259.34 / $14,267.33
| Facility | | $3,873.15 | $6,259.34 | $14,267.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.38 / $2,451.38 / $2,522.40
| Professional | | $2,451.38 | $2,451.38 | $2,522.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.04 / $2,114.46 / $10,228.89
| Facility | | $678.04 | $2,114.46 | $10,228.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.78 / $1,109.56 / $2,198.75
| Professional | | $679.78 | $1,109.56 | $2,198.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.65 / $1,347.44 / $1,359.57
| Facility | | $1.65 | $1,347.44 | $1,359.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.78 / $1,019.68 / $2,180.15
| Professional | | $679.78 | $1,019.68 | $2,180.15 |