- 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
- $29.15 / $70.58 / $222.72
| Professional | | $29.15 | $70.58 | $222.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.58 / $74.69 / $322.43
| Professional | | $39.58 | $74.69 | $322.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.65 / $65.14 / $314.83
| Professional | | $36.65 | $65.14 | $314.83 |
- 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
- $151.90 / $200.28 / $287.88
| Professional | | $151.90 | $200.28 | $287.88 |