- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.68 / $1,821.00 / $9,477.00
| Facility | | $168.68 | $1,821.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.68 / $215.20 / $309.98
| Professional | | $168.68 | $215.20 | $309.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.07 / $3,206.07 / $3,206.07
| Facility | | $3,206.07 | $3,206.07 | $3,206.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,626.00
| Facility | | $1,240.00 | $2,311.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.05 / $347.38 / $498.82
| Professional | | $248.05 | $347.38 | $498.82 |