- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.47 / $471.54 / $60,764.43
| Facility | | $183.47 | $471.54 | $60,764.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.47 / $183.48 / $221.93
| Professional | | $183.47 | $183.48 | $221.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.05 / $189.05 / $189.05
| Facility | | $189.05 | $189.05 | $189.05 |
- 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
- $600.27 / $600.27 / $600.27
| Facility | | $600.27 | $600.27 | $600.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $194.49 / $275.22
| Professional | | $183.48 | $194.49 | $275.22 |