- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $12,882.50 / $23,988.33
| Facility | | $3,388.44 | $12,882.50 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,412.54 / $9,120.11
| Professional | | $851.14 | $1,412.54 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $50.12 / $64.57
| Professional | | $44.67 | $50.12 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,454.71 / $37,153.52
| Facility | | $707.95 | $2,454.71 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |