- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,715.19 / $47,863.01
| Facility | | $3,981.07 | $10,715.19 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $11,220.18 / $13,182.57
| Facility | | $5,888.44 | $11,220.18 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,677.35 / $5,011.87
| Professional | | $3,981.07 | $4,677.35 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $1,513.56 / $3,801.89
| Facility | | $3.80 | $1,513.56 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $4,365.16
| Professional | | $3,801.89 | $3,801.89 | $4,365.16 |