- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,981.07 / $6,760.83
| Facility | | $275.42 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $1,479.11
| Professional | | $295.12 | $512.86 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,413.10 / $15,135.61
| Facility | | $380.19 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $1,148.15
| Professional | | $575.44 | $691.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,715.19 / $15,848.93
| Facility | | $7,413.10 | $10,715.19 | $15,848.93 |