- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.60 / $5,041.00 / $10,651.00
| Facility | | $257.60 | $5,041.00 | $10,651.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $257.60 / $1,456.81
| Professional | | $47.86 | $257.60 | $1,456.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.88 / $31.93 / $55.75
| Professional | | $10.88 | $31.93 | $55.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $7.60 / $7.60
| Professional | | $7.60 | $7.60 | $7.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.60 / $257.60 / $432.77
| Facility | | $257.60 | $257.60 | $432.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.00 / $468.00 / $468.00
| Professional | | $468.00 | $468.00 | $468.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,464.00 / $3,011.00
| Facility | | $730.00 | $1,464.00 | $3,011.00 |