- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $758.58
| Professional | | $190.55 | $275.42 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $9,772.37 / $13,182.57
| Facility | | $8,128.31 | $9,772.37 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $323.59 / $363.08
| Professional | | $229.09 | $323.59 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $14,454.40 / $15,135.61
| Facility | | $13,803.84 | $14,454.40 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $389.05
| Professional | | $208.93 | $309.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,698.24 / $3,090.30
| Facility | | $645.65 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $229.09 / $354.81
| Professional | | $162.18 | $229.09 | $354.81 |