- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.31 / $1,848.00 / $7,885.76
| Facility | | $402.31 | $1,848.00 | $7,885.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,284.98 / $4,375.02 / $6,875.82
| Facility | | $2,284.98 | $4,375.02 | $6,875.82 |
- 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
- $353.42 / $536.74 / $1,370.59
| Professional | | $353.42 | $536.74 | $1,370.59 |
- 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
- $1,282.00 / $3,751.00 / $6,625.00
| Facility | | $1,282.00 | $3,751.00 | $6,625.00 |