- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,786.26 / $3,786.26 / $5,397.08
| Facility | | $3,786.26 | $3,786.26 | $5,397.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.06 / $4,047.81 / $4,047.81
| Professional | | $1,453.06 | $4,047.81 | $4,047.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,095.62 / $8,095.62 / $8,095.62
| Facility | | $8,095.62 | $8,095.62 | $8,095.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,971.28 / $2,385.08 / $2,981.34
| Professional | | $1,971.28 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,972.01 / $4,047.81 / $4,290.68
| Facility | | $1,972.01 | $4,047.81 | $4,290.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,075.80 / $2,075.80 / $2,490.96
| Professional | | $2,075.80 | $2,075.80 | $2,490.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,113.70 / $5,189.50 / $7,472.88
| Facility | | $3,113.70 | $5,189.50 | $7,472.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,764.43 / $3,102.41 / $3,102.41
| Professional | | $1,764.43 | $3,102.41 | $3,102.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $871.84 / $2,490.96
| Professional | | $871.84 | $871.84 | $2,490.96 |