- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,235.94 / $6,760.83
| Facility | | $645.65 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $467.74 / $831.76
| Professional | | $269.15 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,621.81 / $7,079.46
| Facility | | $549.54 | $1,621.81 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $977.24
| Professional | | $588.84 | $851.14 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,888.44 / $7,762.47
| Facility | | $3,467.37 | $5,888.44 | $7,762.47 |