- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.47 / $1,892.00 / $8,108.37
| Facility | | $315.47 | $1,892.00 | $8,108.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,502.50 / $3,096.34 / $5,756.93
| Facility | | $1,502.50 | $3,096.34 | $5,756.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $620.00 / $643.00
| Facility | | $620.00 | $620.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.16 / $370.46 / $1,132.68
| Professional | | $250.16 | $370.46 | $1,132.68 |
- 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
- $930.00 / $3,951.00 / $6,625.00
| Facility | | $930.00 | $3,951.00 | $6,625.00 |