- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.02 / $465.49 / $25,000.00
| Facility | | $267.02 | $465.49 | $25,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.61 / $152.28 / $824.25
| Professional | | $118.61 | $152.28 | $824.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.66 / $211.83 / $523.86
| Facility | | $89.66 | $211.83 | $523.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.84 / $89.66 / $211.83
| Professional | | $72.84 | $89.66 | $211.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.23 / $14.23 / $14.23
| Professional | | $14.23 | $14.23 | $14.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.61 / $161.41 / $322.22
| Facility | | $118.61 | $161.41 | $322.22 |