- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,090.30 / $6,760.83
| Facility | | $316.23 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $891.25
| Professional | | $190.55 | $331.13 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,819.70 / $6,606.93
| Facility | | $323.59 | $1,819.70 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $446.68 / $588.84
| Professional | | $398.11 | $446.68 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,370.32 / $7,413.10
| Facility | | $3,019.95 | $5,370.32 | $7,413.10 |