- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.52 / $1,121.30 / $4,840.66
| Facility | | $448.52 | $1,121.30 | $4,840.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.52 / $660.09 / $719.33
| Professional | | $448.52 | $660.09 | $719.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.23 / $1,249.92 / $2,664.42
| Facility | | $827.23 | $1,249.92 | $2,664.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.39 / $1,108.60 / $1,541.90
| Professional | | $592.39 | $1,108.60 | $1,541.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.38 / $192.38 / $8,702.00
| Facility | | $192.38 | $192.38 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.19 / $507.76 / $863.20
| Professional | | $351.19 | $507.76 | $863.20 |