- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $1,659.59 / $1,949.84
| Facility | | $30.20 | $1,659.59 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $2,398.83
| Professional | | $30.20 | $47.86 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $1,698.24
| Professional | | $776.25 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,737.80 / $2,754.23
| Professional | | $1,122.02 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,089.30 / $3,388.44
| Professional | | $977.24 | $2,089.30 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $34.67 / $81.28
| Professional | | $20.89 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $67.61 / $89.13
| Professional | | $50.12 | $67.61 | $89.13 |