- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.04 / $5,242.26 / $18,612.70
| Facility | | $101.04 | $5,242.26 | $18,612.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.09 / $31.39 / $32.33
| Professional | | $31.09 | $31.39 | $32.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.76 / $20.89 / $51.00
| Facility | | $20.76 | $20.89 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.41 / $20.41 / $20.41
| Professional | | $20.41 | $20.41 | $20.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.05 / $20.41 / $20.41
| Facility | | $18.05 | $20.41 | $20.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.41 / $20.41 / $20.41
| Professional | | $20.41 | $20.41 | $20.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.68 / $34.68 / $34.68
| Professional | | $34.68 | $34.68 | $34.68 |