- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $380.19 / $457.09
| Professional | | $363.08 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $389.05
| Professional | | $281.84 | $363.08 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $467.74 / $3,311.31
| Facility | | $257.04 | $467.74 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,818.38
| Professional | | $2,454.71 | $2,454.71 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $2,754.23
| Professional | | $2,137.96 | $2,630.27 | $2,754.23 |