- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.55 / $116.37 / $174.26
| Professional | | $103.55 | $116.37 | $174.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.64 / $1,368.33 / $4,858.28
| Facility | | $1,228.64 | $1,368.33 | $4,858.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.93 / $134.84 / $474.33
| Professional | | $129.93 | $134.84 | $474.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.31 / $1,981.08 / $3,482.61
| Facility | | $379.31 | $1,981.08 | $3,482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.06 / $164.87 / $264.89
| Professional | | $106.06 | $164.87 | $264.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.17 / $132.34 / $224.74
| Professional | | $74.17 | $132.34 | $224.74 |