- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $32.36 / $56.23
| Professional | | $19.95 | $32.36 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $831.76
| Facility | | $524.81 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $36.31 / $457.09
| Professional | | $16.22 | $36.31 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $23.99 / $38.02
| Professional | | $17.38 | $23.99 | $38.02 |