- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $7,762.47
| Professional | | $2,884.03 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,585.78 / $10,964.78
| Facility | | $7,079.46 | $7,585.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,495.41 / $5,888.44
| Professional | | $5,248.07 | $5,495.41 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,265.80 / $5,370.32
| Professional | | $3,388.44 | $4,265.80 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $11,220.18
| Facility | | $3,388.44 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $7,762.47
| Professional | | $2,884.03 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,495.41 / $5,888.44
| Professional | | $5,248.07 | $5,495.41 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $15,488.17 / $26,302.68
| Facility | | $3,715.35 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,162.28 / $4,677.35
| Professional | | $2,344.23 | $3,162.28 | $4,677.35 |