- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.60 / $2,563.00 / $6,446.00
| Facility | | $282.60 | $2,563.00 | $6,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.25 / $210.48 / $509.86
| Professional | | $89.25 | $210.48 | $509.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.97 / $367.12 / $5,582.51
| Facility | | $225.97 | $367.12 | $5,582.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.65 / $355.37 / $1,813.25
| Facility | | $228.65 | $355.37 | $1,813.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |