- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,388.44 / $4,570.88
| Facility | | $2,951.21 | $3,388.44 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $630.96 / $3,981.07
| Professional | | $147.91 | $630.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $151.36
| Professional | | $30.20 | $44.67 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $398.11 / $870.96
| Facility | | $338.84 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |