- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.83 / $157.83 / $190.01
| Professional | | $157.83 | $157.83 | $190.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.00 / $346.00 / $519.00
| Professional | | $293.00 | $346.00 | $519.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.34 / $264.89 / $331.23
| Professional | | $183.34 | $264.89 | $331.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.36 / $366.23 / $567.59
| Professional | | $218.36 | $366.23 | $567.59 |