- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.60 / $1,842.00 / $7,914.07
| Facility | | $695.60 | $1,842.00 | $7,914.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,773.17 / $5,741.78 / $11,796.02
| Facility | | $3,773.17 | $5,741.78 | $11,796.02 |
- 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
- $588.37 / $944.21 / $2,528.02
| Professional | | $588.37 | $944.21 | $2,528.02 |
- 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
- $1,152.00 / $5,000.00 / $8,995.00
| Facility | | $1,152.00 | $5,000.00 | $8,995.00 |