- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,388.44 / $7,943.28
| Facility | | $363.08 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $407.38 / $933.25
| Professional | | $223.87 | $407.38 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,570.88 / $9,549.93
| Facility | | $457.09 | $4,570.88 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $933.25
| Professional | | $537.03 | $616.60 | $933.25 |
- 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 |