- 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
- $41.53 / $67.64 / $107.49
| Professional | | $41.53 | $67.64 | $107.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.48 / $78.40 / $124.54
| Professional | | $46.48 | $78.40 | $124.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.68 / $97.35 / $148.77
| Professional | | $66.68 | $97.35 | $148.77 |
- 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
- $67.65 / $109.57 / $167.39
| Professional | | $67.65 | $109.57 | $167.39 |