- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.08 / $80.08 / $83.09
| Professional | | $80.08 | $80.08 | $83.09 |
- 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
- $631.96 / $894.85 / $1,301.30
| Professional | | $631.96 | $894.85 | $1,301.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.58 / $2,448.46 / $3,809.82
| Professional | | $2,199.58 | $2,448.46 | $3,809.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.08 / $80.08 / $83.09
| Professional | | $80.08 | $80.08 | $83.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.57 / $117.22 / $2,832.88
| Professional | | $85.57 | $117.22 | $2,832.88 |