- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.38 / $1,518.41 / $5,956.65
| Facility | | $223.38 | $1,518.41 | $5,956.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.83 / $26.03 / $32.85
| Professional | | $14.83 | $26.03 | $32.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.61 / $36.11 / $57.25
| Professional | | $21.61 | $36.11 | $57.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.44 / $43.51 / $82.51
| Professional | | $27.44 | $43.51 | $82.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.21 / $53.29 / $91.41
| Professional | | $32.21 | $53.29 | $91.41 |