- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.41 / $183.41 / $135,704.24
| Facility | | $183.41 | $183.41 | $135,704.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $185.31 / $251.97
| Professional | | $183.48 | $185.31 | $251.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.71 / $217.31 / $217.31
| Professional | | $184.71 | $217.31 | $217.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.09 / $173.09 / $173.09
| Facility | | $173.09 | $173.09 | $173.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $225.02 / $259.64
| Professional | | $183.48 | $225.02 | $259.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $183.48
| Professional | | $183.48 | $183.48 | $183.48 |