- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,548.13 / $8,511.38
| Facility | | $275.42 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,398.83 / $4,570.88
| Facility | | $891.25 | $2,398.83 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $281.84 / $1,071.52
| Professional | | $173.78 | $281.84 | $1,071.52 |
- 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
- $151.36 / $831.76 / $2,630.27
| Facility | | $151.36 | $831.76 | $2,630.27 |