- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $5,248.07 / $7,943.28
| Facility | | $331.13 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $1,023.29
| Professional | | $269.15 | $436.52 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,951.21 / $8,709.64
| Facility | | $478.63 | $2,951.21 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $912.01
| Professional | | $602.56 | $602.56 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,309.57 / $8,912.51
| Facility | | $4,265.80 | $6,309.57 | $8,912.51 |