- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $5,370.32 / $7,943.28
| Facility | | $269.15 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $316.23 / $831.76
| Professional | | $181.97 | $316.23 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $6,606.93
| Facility | | $275.42 | $446.68 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $426.58 / $645.65
| Professional | | $407.38 | $426.58 | $645.65 |
- 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 |