- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,709.64 / $11,481.54
| Facility | | $7,585.78 | $8,709.64 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $8,709.64
| Professional | | $2,691.53 | $5,888.44 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $891.25
| Facility | | $549.54 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $4,897.79
| Professional | | $371.54 | $501.19 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,165.95 / $16,595.87
| Facility | | $4,786.30 | $6,165.95 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,760.83 / $7,585.78
| Facility | | $3,162.28 | $6,760.83 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $4,570.88
| Professional | | $3,162.28 | $3,162.28 | $4,570.88 |