- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,862.09 / $5,623.41
| Facility | | $549.54 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,413.10 / $10,232.93
| Facility | | $3,311.31 | $7,413.10 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,000.00 / $5,623.41
| Facility | | $302.00 | $1,000.00 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $707.95 / $1,548.82
| Professional | | $398.11 | $707.95 | $1,548.82 |
- 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
- $1,096.48 / $4,265.80 / $7,585.78
| Facility | | $1,096.48 | $4,265.80 | $7,585.78 |