- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $5,370.32 / $7,943.28
| Facility | | $346.74 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $794.33
| Professional | | $213.80 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $616.60 / $6,606.93
| Facility | | $371.54 | $616.60 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $933.25
| Professional | | $501.19 | $616.60 | $933.25 |
- 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 |