- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,344.23 / $2,344.23
| Facility | | $891.25 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $128.82 / $933.25
| Professional | | $6.03 | $128.82 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $1,000.00
| Professional | | $50.12 | $70.79 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $173.78 / $794.33
| Facility | | $10.47 | $173.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,096.48 / $1,949.84
| Professional | | $1,000.00 | $1,096.48 | $1,949.84 |