- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $181.97 / $218.78
| Professional | | $128.82 | $181.97 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181,970.09 / $181,970.09 / $537,031.80
| Facility | | $181,970.09 | $181,970.09 | $537,031.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $288.40
| Professional | | $218.78 | $218.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $91.20 / $102.33
| Professional | | $57.54 | $91.20 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $95.50 / $154.88
| Professional | | $63.10 | $95.50 | $154.88 |