- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $5,370.32 / $7,943.28
| Facility | | $251.19 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $676.08
| Professional | | $173.78 | $302.00 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $426.58 / $6,606.93
| Facility | | $263.03 | $426.58 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $407.38 / $616.60
| Professional | | $389.05 | $407.38 | $616.60 |
- 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 |