- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $95.50 / $213.80
| Professional | | $47.86 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $87.10 / $154.88
| Professional | | $42.66 | $87.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $93.33 / $269.15
| Professional | | $33.88 | $93.33 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,511.89 / $6,025.60
| Facility | | $1,380.38 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $100.00 / $213.80
| Professional | | $53.70 | $100.00 | $213.80 |