- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.93 / $3,701.00 / $8,409.15
| Facility | | $506.93 | $3,701.00 | $8,409.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.76 / $551.03 / $850.00
| Professional | | $204.76 | $551.03 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.83 / $889.92 / $7,155.00
| Facility | | $464.83 | $889.92 | $7,155.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.54 / $890.10 / $3,093.19
| Facility | | $512.54 | $890.10 | $3,093.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |