- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,235.94 / $10,000.00
| Facility | | $1,023.29 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $17,378.01
| Facility | | $3,311.31 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,318.26 / $4,466.84
| Professional | | $724.44 | $1,318.26 | $4,466.84 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |