- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $10,232.93 / $15,848.93
| Facility | | $223.87 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $33.88
| Professional | | $30.20 | $30.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $41.69 / $46.77
| Facility | | $32.36 | $41.69 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $100.00 / $147.91
| Facility | | $77.62 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $29.51 / $36.31
| Professional | | $26.30 | $29.51 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $40.74 / $42.66
| Professional | | $30.20 | $40.74 | $42.66 |