- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.62 / $86.70 / $101.04
| Professional | | $73.62 | $86.70 | $101.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.16 / $1,006.02 / $1,174.58
| Facility | | $581.16 | $1,006.02 | $1,174.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.78 / $113.59 / $187.21
| Professional | | $93.78 | $113.59 | $187.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.08 / $1,242.66 / $2,184.52
| Facility | | $309.08 | $1,242.66 | $2,184.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.55 / $160.49 / $170.79
| Professional | | $117.55 | $160.49 | $170.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.84 / $114.31 / $164.74
| Professional | | $58.84 | $114.31 | $164.74 |