- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.62 / $1,678.00 / $5,956.33
| Facility | | $375.62 | $1,678.00 | $5,956.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.54 / $3,401.23 / $7,272.14
| Facility | | $1,528.54 | $3,401.23 | $7,272.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $908.00 / $9,951.00
| Facility | | $400.00 | $908.00 | $9,951.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.87 / $623.17 / $2,005.06
| Professional | | $394.87 | $623.17 | $2,005.06 |
- 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
- $815.00 / $2,588.00 / $4,780.00
| Facility | | $815.00 | $2,588.00 | $4,780.00 |