- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,600.00 / $2,668.00
| Facility | | $1,500.00 | $1,600.00 | $2,668.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,500.00 / $1,600.00
| Professional | | $1,000.00 | $1,500.00 | $1,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.97 / $401.83 / $3,111.00
| Professional | | $392.97 | $401.83 | $3,111.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.55 / $1,517.55 / $1,517.55
| Facility | | $1,517.55 | $1,517.55 | $1,517.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.00 / $141.00 / $141.00
| Professional | | $141.00 | $141.00 | $141.00 |