- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.00 / $2,145.78 / $7,838.38
| Facility | | $1,047.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.00 / $1,084.00 / $9,334.40
| Professional | | $1,084.00 | $1,084.00 | $9,334.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.16 / $403.43 / $675.85
| Facility | | $168.16 | $403.43 | $675.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $1,500.00
| Professional | | $60.00 | $85.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.36 / $1,327.00 / $1,327.00
| Facility | | $458.36 | $1,327.00 | $1,327.00 |