- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,511.89 / $7,762.47
| Facility | | $831.76 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,981.07 / $8,317.64
| Facility | | $2,041.74 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,288.25 / $2,691.53
| Facility | | $398.11 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $891.25 / $2,187.76
| Professional | | $489.78 | $891.25 | $2,187.76 |
- 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
- $891.25 / $2,290.87 / $5,128.61
| Facility | | $891.25 | $2,290.87 | $5,128.61 |