- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $288.40 / $1,905.46
| Professional | | $87.10 | $288.40 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,041.74
| Facility | | $1,258.93 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $436.52
| Professional | | $125.89 | $125.89 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $549.54 / $1,548.82
| Facility | | $251.19 | $549.54 | $1,548.82 |