- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,140.00 / $3,140.00 / $6,907.00
| Facility | | $3,140.00 | $3,140.00 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.84 / $79.81 / $210.02
| Professional | | $23.84 | $79.81 | $210.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.60 / $129.51 / $264.89
| Professional | | $25.60 | $129.51 | $264.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.00 / $440.00 / $440.00
| Facility | | $440.00 | $440.00 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.79 / $189.03 / $349.34
| Professional | | $31.79 | $189.03 | $349.34 |