- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.13 / $240.65 / $257.32
| Professional | | $220.13 | $240.65 | $257.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,147.00 / $3,147.00 / $3,147.00
| Professional | | $3,147.00 | $3,147.00 | $3,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.31 / $2,060.31 / $2,060.31
| Facility | | $2,060.31 | $2,060.31 | $2,060.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.22 / $363.26 / $514.36
| Professional | | $285.22 | $363.26 | $514.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.43 / $263.82 / $441.99
| Professional | | $202.43 | $263.82 | $441.99 |