- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,248.07 / $7,943.28
| Facility | | $977.24 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $2,041.74
| Professional | | $549.54 | $870.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $9,772.37
| Facility | | $954.99 | $1,659.59 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,380.38 / $1,698.24
| Professional | | $1,230.27 | $1,380.38 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,511.38 / $11,748.98
| Facility | | $5,128.61 | $8,511.38 | $11,748.98 |