- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,162.28 / $8,511.38
| Facility | | $933.25 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $61.66 / $363.08
| Professional | | $47.86 | $61.66 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $18,197.01
| Facility | | $7,413.10 | $12,302.69 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $9,332.54 / $21,379.62
| Facility | | $1,202.26 | $9,332.54 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $75.86 / $117.49
| Professional | | $47.86 | $75.86 | $117.49 |