- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,393.15 / $5,430.00
| Facility | | $1,017.00 | $2,393.15 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,907.66 / $16,914.80 / $33,871.87
| Facility | | $7,907.66 | $16,914.80 | $33,871.87 |
- 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
- $1,452.62 / $2,133.08 / $5,230.13
| Professional | | $1,452.62 | $2,133.08 | $5,230.13 |
- 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
- $2,421.00 / $7,842.00 / $21,651.00
| Facility | | $2,421.00 | $7,842.00 | $21,651.00 |