- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,630.27 / $8,511.38
| Facility | | $660.69 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $380.19
| Professional | | $263.03 | $331.13 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $3,981.07
| Facility | | $776.25 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,023.29 / $2,187.76
| Facility | | $338.84 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $707.95
| Professional | | $316.23 | $467.74 | $707.95 |