- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,887.22 / $11,100.08 / $28,444.17
| Facility | | $3,887.22 | $11,100.08 | $28,444.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.20 / $1,866.40 / $2,084.01
| Professional | | $933.20 | $1,866.40 | $2,084.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,832.80 / $7,594.08 / $9,719.69
| Facility | | $6,832.80 | $7,594.08 | $9,719.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |