- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.44 / $8,956.00 / $11,627.00
| Facility | | $286.44 | $8,956.00 | $11,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.69 / $286.44 / $442.28
| Professional | | $250.69 | $286.44 | $442.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.00 / $380.65 / $610.39
| Professional | | $331.00 | $380.65 | $610.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,010.50 / $13,010.50 / $16,052.30
| Facility | | $13,010.50 | $13,010.50 | $16,052.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $60.00
| Professional | | $60.00 | $60.00 | $60.00 |