- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.61 / $902.67 / $9,733.37
| Facility | | $246.61 | $902.67 | $9,733.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.17 / $246.61 / $428.41
| Professional | | $94.17 | $246.61 | $428.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.11 / $207.35 / $684.53
| Professional | | $127.11 | $207.35 | $684.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.49 / $797.49 / $797.49
| Facility | | $797.49 | $797.49 | $797.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.40 / $590.16 / $1,323.88
| Professional | | $455.40 | $590.16 | $1,323.88 |