- 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
- $23.76 / $49.62 / $64.09
| Professional | | $23.76 | $49.62 | $64.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.22 / $44.93 / $85.48
| Professional | | $26.22 | $44.93 | $85.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.85 / $57.23 / $124.30
| Professional | | $26.85 | $57.23 | $124.30 |
- 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
- $49.66 / $79.55 / $133.62
| Professional | | $49.66 | $79.55 | $133.62 |