- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $117.49 / $125.89
| Professional | | $100.00 | $117.49 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181,970.09 / $181,970.09 / $537,031.80
| Facility | | $181,970.09 | $181,970.09 | $537,031.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $138.04
| Professional | | $104.71 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $60.26 / $89.13
| Professional | | $40.74 | $60.26 | $89.13 |