- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.05 / $3,107.00 / $8,783.00
| Facility | | $990.05 | $3,107.00 | $8,783.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,107.35 / $7,479.64 / $12,405.48
| Facility | | $4,107.35 | $7,479.64 | $12,405.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.00 / $1,855.00 / $1,923.00
| Facility | | $1,855.00 | $1,855.00 | $1,923.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.32 / $990.05 / $2,736.21
| Professional | | $617.32 | $990.05 | $2,736.21 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |