- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.77 / $1,060.57 / $1,060.57
| Professional | | $433.77 | $1,060.57 | $1,060.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.00 / $370.00 / $553.00
| Facility | | $370.00 | $370.00 | $553.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $45.00 / $67.26
| Professional | | $1.37 | $45.00 | $67.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.97 / $501.97 / $501.97
| Facility | | $501.97 | $501.97 | $501.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $700.00 / $700.00
| Facility | | $480.00 | $700.00 | $700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $1.81 / $1.81
| Professional | | $1.54 | $1.81 | $1.81 |