- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,265.80 / $11,220.18
| Facility | | $1,122.02 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,471.29 / $14,791.08
| Facility | | $6,918.31 | $10,471.29 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,122.02 / $3,715.35
| Professional | | $691.83 | $1,122.02 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,244.36 / $16,982.44
| Facility | | $1,778.28 | $7,244.36 | $16,982.44 |