- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.00 / $2,200.00 / $5,091.00
| Facility | | $813.00 | $2,200.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,677.08 / $13,450.10 / $29,336.37
| Facility | | $7,677.08 | $13,450.10 | $29,336.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $7,619.73 / $8,506.52
| Facility | | $620.00 | $7,619.73 | $8,506.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.71 / $2,187.54 / $7,978.41
| Professional | | $1,468.71 | $2,187.54 | $7,978.41 |
- 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
- $2,100.00 / $5,820.00 / $12,241.00
| Facility | | $2,100.00 | $5,820.00 | $12,241.00 |