- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.78 / $2,678.00 / $7,602.00
| Facility | | $1,201.78 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.78 / $1,201.78 / $1,201.78
| Professional | | $1,201.78 | $1,201.78 | $1,201.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $139.00 / $388.00
| Facility | | $108.00 | $139.00 | $388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.00 / $788.00 / $2,495.00
| Facility | | $267.00 | $788.00 | $2,495.00 |