- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,128.61 / $7,762.47
| Facility | | $1,659.59 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $2,041.74
| Professional | | $1,479.11 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,220.18 / $46,773.51
| Professional | | $7,079.46 | $11,220.18 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,073.80 / $4,365.16
| Professional | | $3,548.13 | $4,073.80 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,489.63 / $52,480.75
| Facility | | $4,897.79 | $13,489.63 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $8,912.51
| Professional | | $1,621.81 | $2,344.23 | $8,912.51 |