- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $5,370.32 / $7,943.28
| Facility | | $120.23 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $123.03 / $426.58
| Professional | | $75.86 | $123.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $5,128.61
| Facility | | $120.23 | $229.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $199.53 / $302.00
| Professional | | $177.83 | $199.53 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,388.44 / $6,309.57
| Facility | | $794.33 | $3,388.44 | $6,309.57 |