- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.98 / $1,981.98 / $1,981.98
| Facility | | $1,981.98 | $1,981.98 | $1,981.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.86 / $1,801.91 / $1,981.98
| Professional | | $814.86 | $1,801.91 | $1,981.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.03 / $2,366.26 / $3,294.95
| Facility | | $2,027.03 | $2,366.26 | $3,294.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,893.01 / $2,247.94 / $2,366.26
| Professional | | $1,893.01 | $2,247.94 | $2,366.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.70 / $7,300.82 / $20,277.41
| Facility | | $1,530.70 | $7,300.82 | $20,277.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.13 / $2,907.71 / $3,483.77
| Professional | | $2,743.13 | $2,907.71 | $3,483.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,334.41 / $7,004.78 / $15,966.46
| Facility | | $4,334.41 | $7,004.78 | $15,966.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.13 / $2,743.13 / $2,822.80
| Professional | | $2,743.13 | $2,743.13 | $2,822.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.73 / $2,357.19 / $9,406.52
| Facility | | $588.73 | $2,357.19 | $9,406.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.25 / $988.67 / $2,376.15
| Professional | | $590.25 | $988.67 | $2,376.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.25 / $1,131.22 / $3,688.28
| Professional | | $590.25 | $1,131.22 | $3,688.28 |