- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.47 / $3,162.96 / $6,967.76
| Facility | | $178.47 | $3,162.96 | $6,967.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.47 / $399.48 / $927.25
| Professional | | $154.47 | $399.48 | $927.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.98 / $342.01 / $1,429.81
| Professional | | $218.98 | $342.01 | $1,429.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.29 / $1,190.29 / $7,752.30
| Facility | | $1,190.29 | $1,190.29 | $7,752.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.26 / $1,278.13 / $2,603.19
| Professional | | $775.26 | $1,278.13 | $2,603.19 |