- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $5,754.40
| Facility | | $4,897.79 | $4,897.79 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $912.01 / $1,584.89
| Professional | | $794.33 | $912.01 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,041.74 / $2,041.74
| Facility | | $275.42 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,445.44 / $2,041.74
| Professional | | $1,288.25 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $2,570.40
| Professional | | $691.83 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,897.79 / $6,918.31
| Facility | | $1,148.15 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,412.54
| Professional | | $831.76 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $1,621.81
| Professional | | $660.69 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,120.11 / $16,595.87
| Facility | | $5,495.41 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,380.38
| Professional | | $831.76 | $1,047.13 | $1,380.38 |