- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $816.46 / $3,578.94
| Professional | | $500.00 | $816.46 | $3,578.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.85 / $359.78 / $1,322.32
| Facility | | $299.85 | $359.78 | $1,322.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.00 / $340.00 / $931.61
| Facility | | $340.00 | $340.00 | $931.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.36 / $1,250.36 / $1,250.36
| Professional | | $1,250.36 | $1,250.36 | $1,250.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.00 / $340.00 / $931.61
| Facility | | $340.00 | $340.00 | $931.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.77 / $327.77 / $1,250.36
| Professional | | $327.77 | $327.77 | $1,250.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.12 / $556.60 / $2,504.69
| Professional | | $243.12 | $556.60 | $2,504.69 |