- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.76 / $8,046.57 / $11,964.05
| Facility | | $213.76 | $8,046.57 | $11,964.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.54 / $205.62 / $279.57
| Professional | | $204.54 | $205.62 | $279.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.71 / $236.82 / $601.10
| Facility | | $112.71 | $236.82 | $601.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $262.68 / $286.86
| Professional | | $203.58 | $262.68 | $286.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.06 / $203.58 / $203.58
| Facility | | $192.06 | $203.58 | $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
- $106.24 / $213.76 / $545.79
| Facility | | $106.24 | $213.76 | $545.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.48 / $361.48 / $361.48
| Professional | | $361.48 | $361.48 | $361.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $215.79 / $226.63
| Professional | | $203.58 | $215.79 | $226.63 |