- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $3,742.00 / $18,600.00
| Facility | | $1,300.00 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,683.00 / $3,684.00 / $6,245.00
| Professional | | $3,683.00 | $3,684.00 | $6,245.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.49 / $149.83 / $217.04
| Facility | | $110.49 | $149.83 | $217.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.58 / $30.04 / $107.02
| Facility | | $29.58 | $30.04 | $107.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $51.64 / $61.26
| Facility | | $10.80 | $51.64 | $61.26 |