- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,786.30
| Facility | | $3,981.07 | $3,981.07 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $2,238.72 / $5,754.40
| Professional | | $501.19 | $2,238.72 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $31,622.78 / $38,018.94
| Facility | | $15,848.93 | $31,622.78 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $33,113.11
| Facility | | $4,466.84 | $8,128.31 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $15,488.17
| Professional | | $630.96 | $933.25 | $15,488.17 |