- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.58 / $1,706.00 / $4,473.00
| Facility | | $146.58 | $1,706.00 | $4,473.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,931.00 / $5,258.00
| Facility | | $3,072.00 | $3,931.00 | $5,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.25 / $1,032.25 / $1,032.25
| Facility | | $1,032.25 | $1,032.25 | $1,032.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.31 / $150.87 / $1,178.45
| Professional | | $81.31 | $150.87 | $1,178.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.45 / $2,021.63 / $2,021.63
| Facility | | $1,178.45 | $2,021.63 | $2,021.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.00 / $2,200.00 / $6,244.00
| Facility | | $721.00 | $2,200.00 | $6,244.00 |