- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.21 / $141.28 / $141.28
| Professional | | $105.21 | $141.28 | $141.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.32 / $338.18 / $339.87
| Professional | | $266.32 | $338.18 | $339.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.05 / $173.05 / $216.31
| Professional | | $173.05 | $173.05 | $216.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.18 / $114.23 / $186.50
| Facility | | $90.18 | $114.23 | $186.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.36 / $404.02 / $1,210.74
| Professional | | $180.36 | $404.02 | $1,210.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.31 / $186.37 / $329.16
| Professional | | $153.31 | $186.37 | $329.16 |