- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.31 / $472.31 / $11,043.08
| Facility | | $472.31 | $472.31 | $11,043.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.62 / $211.80 / $256.76
| Professional | | $205.62 | $211.80 | $256.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.00 / $247.29 / $645.15
| Facility | | $197.00 | $247.29 | $645.15 |
- 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
- $203.58 / $203.58 / $218.37
| Facility | | $203.58 | $203.58 | $218.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $203.58
| Professional | | $203.58 | $203.58 | $203.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.72 / $193.72 / $234.59
| Professional | | $193.72 | $193.72 | $234.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.31 / $472.31 / $11,043.08
| Facility | | $472.31 | $472.31 | $11,043.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.62 / $222.71 / $279.57
| Professional | | $205.62 | $222.71 | $279.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.72 / $203.58 / $305.37
| Professional | | $193.72 | $203.58 | $305.37 |