- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.57 / $304.97 / $3,705.38
| Facility | | $17.57 | $304.97 | $3,705.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.14 / $121.70 / $194.06
| Professional | | $102.14 | $121.70 | $194.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.90 / $119.90 / $119.90
| Professional | | $119.90 | $119.90 | $119.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.00 / $258.00 / $317.00
| Professional | | $258.00 | $258.00 | $317.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Professional | | $150.00 | $150.00 | $150.00 |