- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.62 / $1,899.73 / $6,224.29
| Facility | | $358.62 | $1,899.73 | $6,224.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.43 / $282.82 / $2,907.59
| Professional | | $70.43 | $282.82 | $2,907.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.97 / $101.97 / $101.97
| Professional | | $101.97 | $101.97 | $101.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.00 / $16.00 / $16.00
| Facility | | $16.00 | $16.00 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.00 / $896.00 / $2,229.00
| Facility | | $361.00 | $896.00 | $2,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $55.00
| Facility | | $55.00 | $55.00 | $55.00 |