- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.18 / $2,562.00 / $4,050.00
| Facility | | $94.18 | $2,562.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.31 / $94.18 / $116.34
| Professional | | $82.31 | $94.18 | $116.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.38 / $2,252.87 / $7,331.51
| Facility | | $1,208.38 | $2,252.87 | $7,331.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.84 / $102.86 / $149.75
| Professional | | $81.84 | $102.86 | $149.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $1,643.00 / $4,516.00
| Facility | | $488.00 | $1,643.00 | $4,516.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.75 / $109.79 / $165.63
| Professional | | $81.75 | $109.79 | $165.63 |