- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.37 / $2,736.91 / $16,369.38
| Facility | | $2,326.37 | $2,736.91 | $16,369.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,326.37 / $2,326.37 / $2,326.37
| Professional | | $2,326.37 | $2,326.37 | $2,326.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.41 / $2,394.80 / $7,275.62
| Facility | | $110.41 | $2,394.80 | $7,275.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,280.76 / $2,326.37 / $2,326.37
| Professional | | $2,280.76 | $2,326.37 | $2,326.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,252.28 / $2,554.44 / $2,554.44
| Facility | | $2,252.28 | $2,554.44 | $2,554.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,554.44 / $2,554.44 / $2,554.44
| Professional | | $2,554.44 | $2,554.44 | $2,554.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.50 / $0.50 / $2,736.91
| Professional | | $0.50 | $0.50 | $2,736.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,487.44 / $2,487.44 / $2,487.44
| Facility | | $2,487.44 | $2,487.44 | $2,487.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.50 / $0.50 / $0.50
| Professional | | $0.50 | $0.50 | $0.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,349.17 / $2,654.57 / $2,736.91
| Professional | | $2,349.17 | $2,654.57 | $2,736.91 |