- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,011.87 / $11,748.98
| Facility | | $3,715.35 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $3,019.95
| Professional | | $2,089.30 | $2,570.40 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $9,549.93
| Facility | | $3,235.94 | $3,235.94 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $15.85
| Professional | | $7.41 | $7.41 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $46,773.51 / $69,183.10
| Facility | | $3,090.30 | $46,773.51 | $69,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $12,589.25
| Facility | | $2,089.30 | $2,089.30 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $3,890.45 / $9,549.93
| Professional | | $9.77 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $3,235.94
| Professional | | $1,348.96 | $1,905.46 | $3,235.94 |