- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,882.50 / $22,908.68
| Facility | | $4,897.79 | $12,882.50 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,090.30 / $7,585.78
| Facility | | $2,238.72 | $3,090.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $3,715.35
| Professional | | $1,737.80 | $2,511.89 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $6,606.93
| Facility | | $891.25 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $1,584.89
| Professional | | $776.25 | $1,023.29 | $1,584.89 |