- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.91 / $3,038.00 / $5,743.00
| Facility | | $502.91 | $3,038.00 | $5,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.14 / $537.84 / $6,201.00
| Professional | | $69.14 | $537.84 | $6,201.00 |
- 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
- $381.48 / $484.37 / $682.89
| Facility | | $381.48 | $484.37 | $682.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,556.00 / $4,495.00
| Facility | | $1,078.00 | $1,556.00 | $4,495.00 |