- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.61 / $7,667.52 / $9,060.19
| Facility | | $3,235.61 | $7,667.52 | $9,060.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.32 / $3,306.43 / $4,972.50
| Professional | | $402.32 | $3,306.43 | $4,972.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.60 / $1,970.98 / $3,563.45
| Facility | | $545.60 | $1,970.98 | $3,563.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.20 / $545.60 / $743.38
| Professional | | $409.20 | $545.60 | $743.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.93 / $1,054.93 / $1,054.93
| Professional | | $1,054.93 | $1,054.93 | $1,054.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.32 / $402.32 / $3,637.07
| Facility | | $402.32 | $402.32 | $3,637.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.32 / $402.32 / $402.32
| Professional | | $402.32 | $402.32 | $402.32 |