- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,548.13 / $8,511.38
| Facility | | $891.25 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $134.90 / $2,290.87
| Professional | | $61.66 | $134.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $3,162.28
| Facility | | $1,258.93 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,230.27 / $4,365.16
| Facility | | $245.47 | $1,230.27 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,230.27 / $4,466.84
| Facility | | $251.19 | $1,230.27 | $4,466.84 |