- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.36 / $187.44 / $286.79
| Professional | | $135.36 | $187.44 | $286.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,639.53 / $2,639.53 / $2,947.78
| Facility | | $2,639.53 | $2,639.53 | $2,947.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.64 / $315.49 / $902.94
| Professional | | $267.64 | $315.49 | $902.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.12 / $254.82 / $564.22
| Professional | | $124.12 | $254.82 | $564.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.12 / $228.06 / $564.22
| Professional | | $125.12 | $228.06 | $564.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.27 / $354.38 / $1,030.21
| Professional | | $298.27 | $354.38 | $1,030.21 |