- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,784.00 / $6,661.00
| Facility | | $1,000.00 | $2,784.00 | $6,661.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,511.67 / $16,067.76 / $32,175.68
| Facility | | $7,511.67 | $16,067.76 | $32,175.68 |
- 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
- $1,379.27 / $2,015.20 / $5,458.32
| Professional | | $1,379.27 | $2,015.20 | $5,458.32 |
- 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 |