- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,981.07 / $6,760.83
| Facility | | $977.24 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $2,187.76
| Professional | | $588.84 | $912.01 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $17,782.79
| Facility | | $977.24 | $1,698.24 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,548.82 / $1,698.24
| Professional | | $1,412.54 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $19,498.45
| Facility | | $5,495.41 | $9,549.93 | $19,498.45 |