- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.51 / $246.61 / $302.52
| Facility | | $244.51 | $246.61 | $302.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.50 / $266.98 / $291.01
| Professional | | $249.50 | $266.98 | $291.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,107.00 / $20,132.00 / $32,157.00
| Facility | | $8,107.00 | $20,132.00 | $32,157.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.13 / $168.58 / $233.01
| Professional | | $154.13 | $168.58 | $233.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,986.00 / $8,986.00 / $9,556.00
| Facility | | $8,986.00 | $8,986.00 | $9,556.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.84 / $215.84 / $215.84
| Professional | | $215.84 | $215.84 | $215.84 |