- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,011.87 / $14,791.08
| Facility | | $812.83 | $5,011.87 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,748.98 / $12,882.50
| Facility | | $7,762.47 | $11,748.98 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $2,630.27
| Professional | | $457.09 | $741.31 | $2,630.27 |
- 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
- $2,570.40 / $6,456.54 / $15,488.17
| Facility | | $2,570.40 | $6,456.54 | $15,488.17 |