- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $5,370.32 / $7,943.28
| Facility | | $524.81 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $1,230.27
| Professional | | $295.12 | $549.54 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $602.56 / $2,137.96
| Facility | | $331.13 | $602.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $870.96
| Professional | | $602.56 | $724.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,897.79 / $7,413.10
| Facility | | $1,318.26 | $4,897.79 | $7,413.10 |