- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.41 / $1,609.00 / $5,549.00
| Facility | | $395.41 | $1,609.00 | $5,549.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.02 / $3,743.36 / $7,496.07
| Facility | | $1,750.02 | $3,743.36 | $7,496.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.40 / $521.73 / $1,128.42
| Professional | | $345.40 | $521.73 | $1,128.42 |
- 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
- $165.00 / $900.00 / $3,686.00
| Facility | | $165.00 | $900.00 | $3,686.00 |