- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,981.07 / $6,760.83
| Facility | | $467.74 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $870.96
| Professional | | $281.84 | $489.78 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,897.79 / $9,549.93
| Facility | | $549.54 | $4,897.79 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $1,096.48
| Professional | | $676.08 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $10,232.93
| Facility | | $4,570.88 | $7,413.10 | $10,232.93 |