- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.32 / $194.59 / $234.41
| Professional | | $165.32 | $194.59 | $234.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,543.62 / $7,039.24 / $8,187.38
| Facility | | $5,543.62 | $7,039.24 | $8,187.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.34 / $272.17 / $408.93
| Professional | | $231.34 | $272.17 | $408.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.53 / $303.12 / $425.74
| Professional | | $215.53 | $303.12 | $425.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.20 / $297.58 / $456.52
| Professional | | $257.20 | $297.58 | $456.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.32 / $234.41 / $279.55
| Professional | | $165.32 | $234.41 | $279.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.66 / $272.11 / $351.86
| Professional | | $187.66 | $272.11 | $351.86 |