- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,466.84 / $10,232.93
| Facility | | $676.08 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $616.60 / $1,023.29
| Professional | | $173.78 | $616.60 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,025.60 / $7,762.47
| Facility | | $1,513.56 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $812.83 / $1,258.93
| Professional | | $257.04 | $812.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $6,606.93
| Facility | | $1,071.52 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $1,230.27
| Professional | | $457.09 | $758.58 | $1,230.27 |