- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.10 / $3,489.13 / $6,446.00
| Facility | | $709.10 | $3,489.13 | $6,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.76 / $243.78 / $464.25
| Professional | | $128.76 | $243.78 | $464.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.31 / $350.69 / $1,341.00
| Facility | | $195.31 | $350.69 | $1,341.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.00 / $375.18 / $528.44
| Facility | | $290.00 | $375.18 | $528.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,623.00 / $2,126.00
| Facility | | $1,204.00 | $1,623.00 | $2,126.00 |