- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,265.80 / $10,000.00
| Facility | | $1,023.29 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,317.64 / $12,022.64
| Facility | | $4,265.80 | $8,317.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $5,623.41
| Facility | | $660.69 | $831.76 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,258.93 / $3,801.89
| Professional | | $724.44 | $1,258.93 | $3,801.89 |
- 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
- $1,096.48 / $4,265.80 / $7,585.78
| Facility | | $1,096.48 | $4,265.80 | $7,585.78 |