- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.40 / $2,747.00 / $6,614.00
| Facility | | $763.40 | $2,747.00 | $6,614.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,472.36 / $7,427.52 / $14,873.60
| Facility | | $3,472.36 | $7,427.52 | $14,873.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.30 / $954.26 / $3,698.04
| Professional | | $648.30 | $954.26 | $3,698.04 |
- 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
- $2,537.00 / $6,885.00 / $14,716.00
| Facility | | $2,537.00 | $6,885.00 | $14,716.00 |