- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $5,128.61 / $14,125.38
| Facility | | $588.84 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $10,471.29
| Facility | | $3,388.44 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $5,623.41
| Facility | | $446.68 | $588.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $2,238.72
| Professional | | $363.08 | $630.96 | $2,238.72 |
- 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
- $1,905.46 / $5,370.32 / $12,302.69
| Facility | | $1,905.46 | $5,370.32 | $12,302.69 |