- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $5,370.32 / $7,943.28
| Facility | | $295.12 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $309.03 / $707.95
| Professional | | $186.21 | $309.03 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $6,606.93
| Facility | | $316.23 | $524.81 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $794.33
| Professional | | $426.58 | $524.81 | $794.33 |
- 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 |