- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $398.11 / $912.01
| Professional | | $371.54 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $954.99 / $1,148.15
| Professional | | $851.14 | $954.99 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $562.34 / $912.01
| Professional | | $549.54 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $29,512.09 / $91,201.08
| Facility | | $22,387.21 | $29,512.09 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,479.11
| Professional | | $537.03 | $724.44 | $1,479.11 |