- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,507.11 / $3,507.11 / $5,052.35
| Facility | | $3,507.11 | $3,507.11 | $5,052.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.25 / $1,826.62 / $1,826.62
| Professional | | $1,360.25 | $1,826.62 | $1,826.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.71 / $4,041.89 / $7,578.54
| Facility | | $1,515.71 | $4,041.89 | $7,578.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,338.07 / $3,789.26 / $4,168.18
| Facility | | $2,338.07 | $3,789.26 | $4,168.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.21 / $1,943.21 / $2,331.85
| Professional | | $1,943.21 | $1,943.21 | $2,331.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $78.00 / $3,789.26
| Professional | | $30.00 | $78.00 | $3,789.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,914.82 / $3,886.42 / $6,995.56
| Facility | | $2,914.82 | $3,886.42 | $6,995.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,904.41 / $2,904.41 / $3,001.18
| Professional | | $2,904.41 | $2,904.41 | $3,001.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $816.15 / $2,914.82
| Professional | | $816.15 | $816.15 | $2,914.82 |