- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,829.24 / $5,743.00 / $9,078.00
| Facility | | $2,829.24 | $5,743.00 | $9,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.20 / $839.08 / $2,390.86
| Professional | | $69.20 | $839.08 | $2,390.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,370.62 / $10,940.20 / $15,943.01
| Facility | | $8,370.62 | $10,940.20 | $15,943.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $7,693.00 / $13,847.00
| Facility | | $2,912.00 | $7,693.00 | $13,847.00 |