- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.97 / $520.97 / $545.16
| Professional | | $520.97 | $520.97 | $545.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,345.31 / $16,010.56 / $18,053.93
| Facility | | $12,345.31 | $16,010.56 | $18,053.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.68 / $425.32 / $668.54
| Professional | | $347.68 | $425.32 | $668.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.42 / $524.37 / $695.76
| Professional | | $419.42 | $524.37 | $695.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.75 / $406.02 / $631.77
| Professional | | $364.75 | $406.02 | $631.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.97 / $520.97 / $545.16
| Professional | | $520.97 | $520.97 | $545.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.77 / $653.17 / $774.14
| Professional | | $469.77 | $653.17 | $774.14 |