- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,452.74 / $14,452.74 / $14,452.74
| Facility | | $14,452.74 | $14,452.74 | $14,452.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.57 / $1,728.49 / $4,253.51
| Professional | | $1,477.57 | $1,728.49 | $4,253.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.25 / $1,844.25 / $2,360.64
| Professional | | $1,844.25 | $1,844.25 | $2,360.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $641.21 / $3,314.62
| Facility | | $507.00 | $641.21 | $3,314.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.50 / $2,244.07 / $4,418.74
| Professional | | $1,580.50 | $2,244.07 | $4,418.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,745.16 / $2,264.32 / $3,435.27
| Professional | | $1,745.16 | $2,264.32 | $3,435.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.00 / $1,003.00 / $2,156.00
| Facility | | $1,003.00 | $1,003.00 | $2,156.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.75 / $1,885.16 / $3,597.27
| Professional | | $1,319.75 | $1,885.16 | $3,597.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.54 / $2,018.58 / $2,478.32
| Professional | | $1,635.54 | $2,018.58 | $2,478.32 |