- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $524.81 / $575.44
| Professional | | $186.21 | $524.81 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $81,283.05 / $95,499.26
| Facility | | $46,773.51 | $81,283.05 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,606.93 / $6,760.83
| Facility | | $4,897.79 | $6,606.93 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,606.93 / $6,760.83
| Professional | | $4,897.79 | $6,606.93 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $85.11
| Professional | | $60.26 | $79.43 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |