- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.60 / $9,561.02 / $12,907.40
| Facility | | $5,224.60 | $9,561.02 | $12,907.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,127.43 / $4,127.43 / $6,008.29
| Professional | | $4,127.43 | $4,127.43 | $6,008.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,791.98 / $7,053.21 / $7,053.21
| Facility | | $6,791.98 | $7,053.21 | $7,053.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,395.99 / $3,395.99 / $3,565.79
| Facility | | $3,395.99 | $3,395.99 | $3,565.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,702.14 / $4,702.14 / $5,224.60
| Facility | | $4,702.14 | $4,702.14 | $5,224.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $7,836.90
| Professional | | $2,194.33 | $3,134.76 | $7,836.90 |