- 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
- $17.09 / $27.38 / $39.88
| Professional | | $17.09 | $27.38 | $39.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.68 / $29.08 / $47.46
| Professional | | $14.68 | $29.08 | $47.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.17 / $34.86 / $68.41
| Professional | | $18.17 | $34.86 | $68.41 |
- 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
- $27.85 / $47.58 / $73.39
| Professional | | $27.85 | $47.58 | $73.39 |