- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,715.35 / $9,772.37
| Facility | | $1,230.27 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $21,379.62 / $40,738.03
| Facility | | $7,762.47 | $21,379.62 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,187.76 / $6,309.57
| Professional | | $1,348.96 | $2,187.76 | $6,309.57 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |