- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.56 / $8,956.00 / $11,627.00
| Facility | | $237.56 | $8,956.00 | $11,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.07 / $237.56 / $546.63
| Professional | | $225.07 | $237.56 | $546.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.00 / $99.12 / $167.62
| Professional | | $84.00 | $99.12 | $167.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,970.10 / $12,970.10 / $16,024.22
| Facility | | $12,970.10 | $12,970.10 | $16,024.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $50.00 / $60.00
| Professional | | $40.00 | $50.00 | $60.00 |