- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.89 / $146.25 / $147.05
| Professional | | $120.89 | $146.25 | $147.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.47 / $1,493.31 / $1,739.95
| Facility | | $628.47 | $1,493.31 | $1,739.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.43 / $205.14 / $311.19
| Professional | | $190.43 | $205.14 | $311.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.77 / $1,302.17 / $2,289.13
| Facility | | $532.77 | $1,302.17 | $2,289.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.80 / $258.89 / $332.71
| Professional | | $140.80 | $258.89 | $332.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.95 / $172.92 / $367.35
| Professional | | $106.95 | $172.92 | $367.35 |