- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $186.21 / $478.63
| Professional | | $162.18 | $186.21 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $426.58 / $512.86
| Professional | | $380.19 | $426.58 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $263.03 / $398.11
| Professional | | $251.19 | $263.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,244.36 / $25,703.96
| Facility | | $6,918.31 | $7,244.36 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $691.83
| Professional | | $218.78 | $323.59 | $691.83 |