- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.53 / $1,694.00 / $5,091.00
| Facility | | $241.53 | $1,694.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.05 / $3,195.02 / $6,264.66
| Facility | | $1,472.05 | $3,195.02 | $6,264.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.02 / $245.84 / $851.16
| Professional | | $169.02 | $245.84 | $851.16 |
- 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
- $930.00 / $3,951.00 / $6,625.00
| Facility | | $930.00 | $3,951.00 | $6,625.00 |