- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.77 / $4,390.00 / $10,767.00
| Facility | | $272.77 | $4,390.00 | $10,767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,166.54 / $16,742.20 / $23,318.49
| Facility | | $10,166.54 | $16,742.20 | $23,318.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.53 / $277.83 / $337.89
| Professional | | $231.53 | $277.83 | $337.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.80 / $314.73 / $445.62
| Facility | | $248.80 | $314.73 | $445.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.28 / $319.55 / $1,621.00
| Facility | | $250.28 | $319.55 | $1,621.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.00 / $3,295.00 / $10,340.00
| Facility | | $1,621.00 | $3,295.00 | $10,340.00 |