- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,062.82 / $5,568.76 / $5,568.76
| Facility | | $3,062.82 | $5,568.76 | $5,568.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.38 / $2,812.22 / $3,062.82
| Professional | | $2,784.38 | $2,812.22 | $3,062.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.70 / $176.51 / $436.50
| Facility | | $74.70 | $176.51 | $436.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.88 / $93.39 / $220.64
| Professional | | $75.88 | $93.39 | $220.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.77 / $2,784.38 / $2,784.38
| Facility | | $2,626.77 | $2,784.38 | $2,784.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.38 / $2,784.38 / $2,784.38
| Professional | | $2,784.38 | $2,784.38 | $2,784.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.42 / $583.00 / $2,784.38
| Facility | | $239.42 | $583.00 | $2,784.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.31 / $530.00 / $530.00
| Professional | | $430.31 | $530.00 | $530.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.38 / $2,784.38 / $2,784.38
| Professional | | $2,784.38 | $2,784.38 | $2,784.38 |