- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,168.69 / $11,220.18
| Facility | | $1,000.00 | $4,168.69 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,244.36 / $18,197.01
| Facility | | $4,466.84 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $3,801.89
| Professional | | $933.25 | $1,513.56 | $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
- $1,698.24 / $4,365.16 / $9,772.37
| Facility | | $1,698.24 | $4,365.16 | $9,772.37 |