- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $4,813.58 / $15,000.00
| Facility | | $3,706.14 | $4,813.58 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.98 / $414.98 / $414.98
| Professional | | $414.98 | $414.98 | $414.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,074.00 / $7,819.00 / $19,195.00
| Facility | | $5,074.00 | $7,819.00 | $19,195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.27 / $261.00 / $401.30
| Professional | | $211.27 | $261.00 | $401.30 |