- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,570.40 / $7,762.47
| Facility | | $977.24 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,022.64 / $15,135.61
| Facility | | $5,888.44 | $12,022.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $870.96 / $2,951.21
| Professional | | $489.78 | $870.96 | $2,951.21 |
- 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
- $2,089.30 / $5,495.41 / $12,882.50
| Facility | | $2,089.30 | $5,495.41 | $12,882.50 |