- 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
- $23.57 / $29.17 / $36.04
| Professional | | $23.57 | $29.17 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $44.51 / $72.61
| Professional | | $0.02 | $44.51 | $72.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.34 / $67.59 / $150.00
| Professional | | $50.34 | $67.59 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.59 / $31.78 / $68.86
| Professional | | $21.59 | $31.78 | $68.86 |