- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.41 / $165.19 / $211.69
| Professional | | $116.41 | $165.19 | $211.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.52 / $3,185.89 / $6,926.75
| Facility | | $1,193.52 | $3,185.89 | $6,926.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.63 / $204.28 / $309.30
| Professional | | $178.63 | $204.28 | $309.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.54 / $1,981.08 / $3,482.61
| Facility | | $529.54 | $1,981.08 | $3,482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.61 / $265.05 / $441.98
| Professional | | $147.61 | $265.05 | $441.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.50 / $244.89 / $516.28
| Professional | | $184.50 | $244.89 | $516.28 |