- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,706.14 / $3,955.04
| Facility | | $3,706.14 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.58 / $903.28 / $1,033.52
| Professional | | $667.58 | $903.28 | $1,033.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.48 / $1,006.45 / $1,618.22
| Professional | | $855.48 | $1,006.45 | $1,618.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $1,062.19 / $1,757.84
| Professional | | $300.00 | $1,062.19 | $1,757.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.87 / $1,218.48 / $1,870.04
| Professional | | $705.87 | $1,218.48 | $1,870.04 |