- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.29 / $400.00 / $400.00
| Professional | | $38.29 | $400.00 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.95 / $86.94 / $102.28
| Professional | | $56.95 | $86.94 | $102.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.84 / $1,183.00 / $4,915.00
| Facility | | $416.84 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.48 / $135.91 / $233.54
| Professional | | $87.48 | $135.91 | $233.54 |