- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $3,090.30 / $6,760.83
| Facility | | $208.93 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $954.99 / $1,548.82
| Professional | | $151.36 | $954.99 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,398.83 / $5,248.07
| Facility | | $331.13 | $2,398.83 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $2,187.76 / $2,884.03
| Professional | | $323.59 | $2,187.76 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $6,309.57
| Facility | | $2,570.40 | $4,677.35 | $6,309.57 |