- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.69 / $2,784.00 / $7,123.00
| Facility | | $958.69 | $2,784.00 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,864.54 / $12,544.48 / $25,120.32
| Facility | | $5,864.54 | $12,544.48 | $25,120.32 |
- 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
- $1,037.93 / $1,628.56 / $3,577.75
| Professional | | $1,037.93 | $1,628.56 | $3,577.75 |
- 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
- $1,400.00 / $3,620.00 / $6,514.00
| Facility | | $1,400.00 | $3,620.00 | $6,514.00 |