- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.00 / $2,118.00 / $5,405.00
| Facility | | $711.00 | $2,118.00 | $5,405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $5,986.58 / $12,294.71
| Facility | | $3,889.58 | $5,986.58 | $12,294.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $3,072.73 / $3,430.33
| Facility | | $709.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.38 / $865.00 / $2,500.96
| Professional | | $580.38 | $865.00 | $2,500.96 |
- 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
- $1,600.00 / $4,530.00 / $8,566.00
| Facility | | $1,600.00 | $4,530.00 | $8,566.00 |