- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.05 / $1,674.05 / $1,807.97
| Facility | | $1,674.05 | $1,674.05 | $1,807.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.29 / $1,807.97 / $3,348.10
| Professional | | $1,558.29 | $1,807.97 | $3,348.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,276.71 / $2,276.71 / $2,276.71
| Professional | | $2,276.71 | $2,276.71 | $2,276.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,823.62 / $3,823.62 / $3,823.62
| Facility | | $3,823.62 | $3,823.62 | $3,823.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,694.60 / $2,694.60 / $2,694.60
| Facility | | $2,694.60 | $2,694.60 | $2,694.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,967.06 / $1,967.06 / $1,967.06
| Professional | | $1,967.06 | $1,967.06 | $1,967.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,419.57 / $20,737.59 / $20,737.59
| Facility | | $17,419.57 | $20,737.59 | $20,737.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,045.47 / $21,045.47 / $24,557.70
| Professional | | $21,045.47 | $21,045.47 | $24,557.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.58 / $2,664.69 / $3,823.62
| Facility | | $1,054.58 | $2,664.69 | $3,823.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.49 / $3,517.73 / $4,251.60
| Professional | | $1,066.49 | $3,517.73 | $4,251.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.58 / $2,682.57 / $3,823.62
| Facility | | $1,054.58 | $2,682.57 | $3,823.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,967.06 / $1,967.06 / $3,483.49
| Professional | | $1,967.06 | $1,967.06 | $3,483.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.29 / $2,013.79 / $2,499.76
| Professional | | $1,361.29 | $2,013.79 | $2,499.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,981.34 / $2,000.39 / $3,823.62
| Professional | | $1,981.34 | $2,000.39 | $3,823.62 |