- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.78 / $3,940.00 / $7,602.00
| Facility | | $100.78 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.55 / $100.78 / $105.79
| Professional | | $70.55 | $100.78 | $105.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.00 / $2,676.00 / $3,710.00
| Facility | | $1,530.00 | $2,676.00 | $3,710.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.67 / $6,887.55 / $6,887.55
| Facility | | $267.67 | $6,887.55 | $6,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,616.00 / $6,003.00
| Facility | | $1,794.00 | $3,616.00 | $6,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.55 / $159.36 / $299.27
| Professional | | $105.55 | $159.36 | $299.27 |