- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.00 / $1,731.00 / $5,091.00
| Facility | | $630.00 | $1,731.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $6,053.72 / $12,446.17
| Facility | | $3,889.58 | $6,053.72 | $12,446.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $3,072.73 / $3,430.33
| Facility | | $620.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.66 / $861.75 / $2,211.21
| Professional | | $592.66 | $861.75 | $2,211.21 |
- 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 |