- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.17 / $1,372.17 / $1,481.94
| Facility | | $1,372.17 | $1,372.17 | $1,481.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.17 / $1,481.94 / $2,744.33
| Professional | | $1,372.17 | $1,481.94 | $2,744.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,866.14 / $1,866.14 / $1,866.14
| Professional | | $1,866.14 | $1,866.14 | $1,866.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,134.11 / $3,134.11 / $3,134.11
| Facility | | $3,134.11 | $3,134.11 | $3,134.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.29 / $1,808.29 / $1,808.29
| Facility | | $1,808.29 | $1,808.29 | $1,808.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.05 / $1,537.05 / $1,537.05
| Professional | | $1,537.05 | $1,537.05 | $1,537.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,133.20 / $15,884.95 / $15,884.95
| Facility | | $15,133.20 | $15,884.95 | $15,884.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,032.90 / $17,032.90 / $26,613.90
| Professional | | $17,032.90 | $17,032.90 | $26,613.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.06 / $2,184.17 / $3,134.11
| Facility | | $932.06 | $2,184.17 | $3,134.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.34 / $2,739.20 / $3,191.85
| Professional | | $1,153.34 | $2,739.20 | $3,191.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.06 / $2,094.12 / $3,134.11
| Facility | | $932.06 | $2,094.12 | $3,134.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.05 / $1,537.05 / $2,653.96
| Professional | | $1,537.05 | $1,537.05 | $2,653.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.11 / $1,779.81 / $2,209.32
| Professional | | $1,203.11 | $1,779.81 | $2,209.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.10 / $1,751.13 / $3,134.11
| Professional | | $1,738.10 | $1,751.13 | $3,134.11 |