- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,884.03 / $9,332.54
| Facility | | $691.83 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $23,988.33 / $33,113.11
| Facility | | $3,630.78 | $23,988.33 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,819.70
| Professional | | $346.74 | $602.56 | $1,819.70 |
- 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
- $2,570.40 / $16,595.87 / $31,622.78
| Facility | | $2,570.40 | $16,595.87 | $31,622.78 |