- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.06 / $1,614.00 / $7,727.00
| Facility | | $108.06 | $1,614.00 | $7,727.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.06 / $108.06 / $108.06
| Professional | | $108.06 | $108.06 | $108.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.50 / $68.50 / $1,021.00
| Professional | | $68.50 | $68.50 | $1,021.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.23 / $237.87 / $237.87
| Professional | | $110.23 | $237.87 | $237.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.00 / $442.00 / $5,940.00
| Facility | | $165.00 | $442.00 | $5,940.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.94 / $183.36 / $259.49
| Professional | | $85.94 | $183.36 | $259.49 |