- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,870.00 / $3,294.00 / $4,387.00
| Facility | | $2,870.00 | $3,294.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.14 / $560.01 / $560.01
| Professional | | $538.14 | $560.01 | $560.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.97 / $447.13 / $651.60
| Facility | | $340.97 | $447.13 | $651.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,556.00 / $4,495.00
| Facility | | $1,078.00 | $1,556.00 | $4,495.00 |