- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.56 / $513.46 / $513.46
| Facility | | $233.56 | $513.46 | $513.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.56 / $513.46 / $2,006.33
| Professional | | $233.56 | $513.46 | $2,006.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.56 / $513.46 / $867.75
| Facility | | $233.56 | $513.46 | $867.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $925.00 / $1,750.00
| Facility | | $100.00 | $925.00 | $1,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $925.00 / $1,750.00
| Professional | | $100.00 | $925.00 | $1,750.00 |