- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,862.09 / $5,623.41
| Facility | | $208.93 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,258.93 / $1,778.28
| Facility | | $724.44 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,698.24 / $2,754.23
| Facility | | $302.00 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $467.74 / $1,000.00
| Professional | | $125.89 | $467.74 | $1,000.00 |
- 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
- $660.69 / $1,445.44 / $3,715.35
| Facility | | $660.69 | $1,445.44 | $3,715.35 |