- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $2,691.53
| Professional | | $32.36 | $47.86 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,202.26 / $1,445.44
| Professional | | $1,047.13 | $1,202.26 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $2,398.83
| Professional | | $1,258.93 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $104.71 / $3,388.44
| Facility | | $34.67 | $104.71 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $56.23 / $5,888.44
| Professional | | $38.02 | $56.23 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |