- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.91 / $2,246.76 / $4,550.00
| Facility | | $388.91 | $2,246.76 | $4,550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.43 / $327.43 / $462.42
| Professional | | $327.43 | $327.43 | $462.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.76 / $75.00 / $100.00
| Professional | | $49.76 | $75.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.31 / $310.31 / $310.31
| Professional | | $310.31 | $310.31 | $310.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.43 / $327.43 / $458.40
| Facility | | $327.43 | $327.43 | $458.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $374.40
| Facility | | $100.00 | $100.00 | $374.40 |