- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.82 / $1,294.36 / $4,718.04
| Facility | | $950.82 | $1,294.36 | $4,718.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.75 / $995.67 / $1,166.09
| Professional | | $672.75 | $995.67 | $1,166.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $139.86 / $171.00
| Professional | | $3.93 | $139.86 | $171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.04 / $6,335.25 / $6,810.24
| Facility | | $583.04 | $6,335.25 | $6,810.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.41 / $1,030.84 / $1,288.56
| Professional | | $475.41 | $1,030.84 | $1,288.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.80 / $448.50 / $1,345.50
| Professional | | $358.80 | $448.50 | $1,345.50 |