- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $5,370.32 / $7,943.28
| Facility | | $245.47 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $602.56
| Professional | | $151.36 | $234.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $436.52 / $6,606.93
| Facility | | $245.47 | $436.52 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $389.05 / $676.08
| Professional | | $346.74 | $389.05 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $7,413.10
| Facility | | $2,137.96 | $5,248.07 | $7,413.10 |