- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,137.96 / $6,456.54
| Facility | | $295.12 | $2,137.96 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $426.58 / $707.95
| Professional | | $102.33 | $426.58 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,230.27 / $2,454.71
| Professional | | $158.49 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $512.86 / $1,905.46
| Professional | | $125.89 | $512.86 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $691.83 / $1,737.80
| Professional | | $275.42 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,737.80 / $5,128.61
| Facility | | $741.31 | $1,737.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $354.81 / $1,698.24
| Professional | | $117.49 | $354.81 | $1,698.24 |