- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.58 / $2,683.00 / $7,602.00
| Facility | | $237.58 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.28 / $237.58 / $273.32
| Professional | | $153.28 | $237.58 | $273.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.00 / $419.00 / $984.65
| Professional | | $419.00 | $419.00 | $984.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.73 / $5,062.89 / $5,062.89
| Facility | | $525.73 | $5,062.89 | $5,062.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.11 / $1,813.11 / $2,601.75
| Professional | | $1,813.11 | $1,813.11 | $2,601.75 |