- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,884.03 / $8,511.38
| Facility | | $416.87 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,762.47 / $10,471.29
| Facility | | $2,089.30 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $8,128.31 / $10,000.00
| Facility | | $398.11 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $660.69 / $1,230.27
| Professional | | $239.88 | $660.69 | $1,230.27 |
- 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
- $1,412.54 / $5,011.87 / $9,772.37
| Facility | | $1,412.54 | $5,011.87 | $9,772.37 |