- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $8,763.29 / $14,860.56
| Facility | | $1,000.00 | $8,763.29 | $14,860.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.79 / $495.01 / $514.94
| Professional | | $485.79 | $495.01 | $514.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $754.04
| Professional | | $60.00 | $85.00 | $754.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,602.00 / $9,127.00 / $10,150.00
| Facility | | $6,602.00 | $9,127.00 | $10,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.13 / $791.95 / $1,203.17
| Professional | | $670.13 | $791.95 | $1,203.17 |