- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.40 / $480.54 / $517.83
| Facility | | $215.40 | $480.54 | $517.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $215.41 / $249.42
| Professional | | $207.13 | $215.41 | $249.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.22 / $230.27 / $656.39
| Facility | | $184.22 | $230.27 | $656.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $214.94
| Professional | | $207.13 | $207.13 | $214.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.90 / $207.13 / $207.13
| Facility | | $204.90 | $207.13 | $207.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $207.13
| Professional | | $207.13 | $207.13 | $207.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $207.13
| Professional | | $207.13 | $207.13 | $207.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.54 / $480.54 / $4,752.00
| Facility | | $480.54 | $480.54 | $4,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $217.48 / $346.30
| Professional | | $207.13 | $217.48 | $346.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.06 / $207.13 / $300.33
| Professional | | $176.06 | $207.13 | $300.33 |