- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $4,908.00 / $12,174.00
| Facility | | $1,110.00 | $4,908.00 | $12,174.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.61 / $655.61 / $1,240.00
| Professional | | $655.61 | $655.61 | $1,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $6.68 / $6.68
| Professional | | $6.68 | $6.68 | $6.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.61 / $1,357.11 / $3,237.00
| Facility | | $655.61 | $1,357.11 | $3,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,306.00 / $3,074.00
| Facility | | $1,216.00 | $2,306.00 | $3,074.00 |