- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.54 / $3,636.00 / $10,750.00
| Facility | | $1,056.54 | $3,636.00 | $10,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,325.75 / $9,953.35 / $21,709.52
| Facility | | $5,325.75 | $9,953.35 | $21,709.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.00 / $11,558.00 / $13,383.00
| Facility | | $1,383.00 | $11,558.00 | $13,383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.08 / $1,477.61 / $5,410.43
| Professional | | $859.08 | $1,477.61 | $5,410.43 |
- 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
- $1,530.00 / $5,951.00 / $12,241.00
| Facility | | $1,530.00 | $5,951.00 | $12,241.00 |