- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,666.54 / $2,666.54 / $15,467.70
| Facility | | $2,666.54 | $2,666.54 | $15,467.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.54 / $2,666.54 / $2,666.54
| Professional | | $2,666.54 | $2,666.54 | $2,666.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,210.01 / $14,807.28 / $23,331.95
| Facility | | $8,210.01 | $14,807.28 | $23,331.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.87 / $986.55 / $1,095.07
| Professional | | $896.87 | $986.55 | $1,095.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.20 / $7,582.20 / $7,582.20
| Facility | | $7,582.20 | $7,582.20 | $7,582.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,934.03 / $14,545.83 / $53,551.61
| Facility | | $7,934.03 | $14,545.83 | $53,551.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,032.88 / $4,082.48 / $11,373.30
| Professional | | $3,032.88 | $4,082.48 | $11,373.30 |