- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.79 / $2,145.78 / $7,838.38
| Facility | | $308.79 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.79 / $319.29 / $319.29
| Professional | | $308.79 | $319.29 | $319.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $85.00 / $3,500.00
| Professional | | $50.00 | $85.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $1,084.00 / $1,401.00
| Facility | | $200.00 | $1,084.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.86 / $460.53 / $635.49
| Professional | | $384.86 | $460.53 | $635.49 |