- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.51 / $3,270.00 / $8,806.00
| Facility | | $1,260.51 | $3,270.00 | $8,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,723.22 / $11,874.81 / $25,900.47
| Facility | | $6,723.22 | $11,874.81 | $25,900.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.35 / $1,705.72 / $5,379.83
| Professional | | $1,017.35 | $1,705.72 | $5,379.83 |
- 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
- $2,050.00 / $5,978.00 / $12,241.00
| Facility | | $2,050.00 | $5,978.00 | $12,241.00 |