- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,576.00 / $5,430.00
| Facility | | $1,017.00 | $2,576.00 | $5,430.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,352.00 / $10,073.00
| Professional | | $1,017.00 | $2,352.00 | $10,073.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $345.40 / $345.40
| Professional | | $120.00 | $345.40 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $2,500.00
| Professional | | $30.00 | $30.00 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |