- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.66 / $4,036.03 / $7,334.64
| Facility | | $204.66 | $4,036.03 | $7,334.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $38.59 / $147.40
| Professional | | $34.65 | $38.59 | $147.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.26 / $58.02 / $94.58
| Facility | | $48.26 | $58.02 | $94.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $13.87 / $17.91
| Professional | | $12.61 | $13.87 | $17.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.40 / $125.40 / $125.40
| Professional | | $125.40 | $125.40 | $125.40 |