- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.47 / $183.48 / $26,675.32
| Facility | | $183.47 | $183.48 | $26,675.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.47 / $183.48 / $220.17
| Professional | | $183.47 | $183.48 | $220.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,571.97 / $12,829.58 / $17,259.89
| Facility | | $10,571.97 | $12,829.58 | $17,259.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $183.48
| Professional | | $183.48 | $183.48 | $183.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $183.48
| Facility | | $183.48 | $183.48 | $183.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $217.31
| Professional | | $183.48 | $183.48 | $217.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.96 / $183.48 / $204.25
| Professional | | $155.96 | $183.48 | $204.25 |