- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.53 / $934.74 / $1,348.38
| Facility | | $858.53 | $934.74 | $1,348.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.53 / $1,002.61 / $3,212.30
| Professional | | $858.53 | $1,002.61 | $3,212.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.22 / $891.03 / $891.03
| Professional | | $673.22 | $891.03 | $891.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,334.00 / $4,334.00 / $4,334.00
| Facility | | $4,334.00 | $4,334.00 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.47 / $759.55 / $1,207.15
| Professional | | $594.47 | $759.55 | $1,207.15 |