- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.14 / $438.14 / $460.24
| Professional | | $438.14 | $438.14 | $460.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,671.44 / $51,449.63 / $58,015.97
| Facility | | $39,671.44 | $51,449.63 | $58,015.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.42 / $598.58 / $718.45
| Professional | | $401.42 | $598.58 | $718.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.91 / $545.34 / $848.55
| Professional | | $489.91 | $545.34 | $848.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.14 / $438.14 / $460.24
| Professional | | $438.14 | $438.14 | $460.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.67 / $605.94 / $731.31
| Professional | | $467.67 | $605.94 | $731.31 |