- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,786.30 / $8,511.38
| Facility | | $724.44 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,918.31 / $13,489.63
| Facility | | $5,248.07 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $588.84 / $5,128.61
| Facility | | $323.59 | $588.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $1,096.48
| Professional | | $676.08 | $851.14 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $8,128.31
| Facility | | $3,630.78 | $5,495.41 | $8,128.31 |