- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.02 / $248.13 / $882.00
| Professional | | $188.02 | $248.13 | $882.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,776.37 / $6,776.37 / $7,320.83
| Facility | | $6,776.37 | $6,776.37 | $7,320.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.43 / $279.43 / $329.38
| Professional | | $279.43 | $279.43 | $329.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.27 / $329.57 / $702.06
| Professional | | $202.27 | $329.57 | $702.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.69 / $329.86 / $702.06
| Professional | | $225.69 | $329.86 | $702.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.24 / $279.54 / $861.71
| Professional | | $252.24 | $279.54 | $861.71 |