- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.40 / $1,272.00 / $7,137.58
| Facility | | $517.40 | $1,272.00 | $7,137.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.94 / $3,818.87 / $8,329.45
| Facility | | $2,340.94 | $3,818.87 | $8,329.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $1,799.73 / $2,009.18
| Facility | | $875.00 | $1,799.73 | $2,009.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.66 / $767.17 / $1,908.40
| Professional | | $471.66 | $767.17 | $1,908.40 |
- 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
- $1,499.00 / $3,751.00 / $6,514.00
| Facility | | $1,499.00 | $3,751.00 | $6,514.00 |