- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.15 / $77.34 / $83.14
| Professional | | $66.15 | $77.34 | $83.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.41 / $2,670.43 / $3,085.73
| Facility | | $594.41 | $2,670.43 | $3,085.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.75 / $83.82 / $175.64
| Professional | | $83.75 | $83.82 | $175.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.55 / $3,298.10 / $5,797.86
| Facility | | $294.55 | $3,298.10 | $5,797.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.31 / $144.46 / $192.55
| Professional | | $87.31 | $144.46 | $192.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.94 / $69.41 / $158.38
| Professional | | $40.94 | $69.41 | $158.38 |