- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,187.00 / $10,575.00
| Facility | | $1,000.00 | $3,187.00 | $10,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,681.94 / $13,967.73 / $21,270.73
| Facility | | $6,681.94 | $13,967.73 | $21,270.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $11,477.00 / $12,682.00
| Facility | | $875.00 | $11,477.00 | $12,682.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.14 / $1,564.77 / $4,953.84
| Professional | | $977.14 | $1,564.77 | $4,953.84 |
- 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
- $2,575.00 / $7,839.00 / $14,468.00
| Facility | | $2,575.00 | $7,839.00 | $14,468.00 |