- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.31 / $3,620.71 / $36,629.12
| Facility | | $239.31 | $3,620.71 | $36,629.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $219.87 / $285.02
| Professional | | $203.58 | $219.87 | $285.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.51 / $246.45 / $259.42
| Facility | | $220.51 | $246.45 | $259.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.50 / $210.50 / $210.50
| Professional | | $210.50 | $210.50 | $210.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.06 / $192.06 / $203.58
| Facility | | $192.06 | $192.06 | $203.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $203.58
| Professional | | $203.58 | $203.58 | $203.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.57 / $248.27 / $297.08
| Facility | | $206.57 | $248.27 | $297.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.59 / $224.93 / $313.52
| Professional | | $204.59 | $224.93 | $313.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $211.80 / $319.92
| Professional | | $203.58 | $211.80 | $319.92 |