- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.63 / $132.74 / $396.56
| Professional | | $72.63 | $132.74 | $396.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.34 / $207.77 / $6,608.00
| Facility | | $156.34 | $207.77 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.95 / $180.47 / $229.14
| Facility | | $120.95 | $180.47 | $229.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |