- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.78 / $362.32 / $10,391.54
| Facility | | $216.78 | $362.32 | $10,391.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.44 / $216.78 / $362.33
| Professional | | $142.44 | $216.78 | $362.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.69 / $230.23 / $336.40
| Professional | | $195.69 | $230.23 | $336.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.24 / $336.34 / $600.30
| Professional | | $196.24 | $336.34 | $600.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.70 / $385.82 / $619.40
| Professional | | $219.70 | $385.82 | $619.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,391.54 / $10,391.54 / $10,391.54
| Facility | | $10,391.54 | $10,391.54 | $10,391.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.34 / $273.27 / $487.53
| Professional | | $179.34 | $273.27 | $487.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.32 / $313.02 / $614.73
| Professional | | $232.32 | $313.02 | $614.73 |