- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,894.55 / $6,774.95 / $18,035.03
| Facility | | $1,894.55 | $6,774.95 | $18,035.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.60 / $279.20 / $1,159.20
| Professional | | $139.60 | $279.20 | $1,159.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.92 / $37.06 / $69.89
| Facility | | $19.92 | $37.06 | $69.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,917.93 / $1,917.93 / $1,917.93
| Professional | | $1,917.93 | $1,917.93 | $1,917.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $1,221.00 / $3,585.00
| Facility | | $358.00 | $1,221.00 | $3,585.00 |