- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,570.40 / $7,762.47
| Facility | | $489.78 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,786.30 / $6,025.60
| Facility | | $2,454.71 | $4,786.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $1,318.26
| Professional | | $194.98 | $323.59 | $1,318.26 |
- 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
- $1,288.25 / $3,548.13 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |