- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $5,370.32 / $7,943.28
| Facility | | $114.82 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $151.36 / $323.59
| Professional | | $81.28 | $151.36 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $6,606.93
| Facility | | $120.23 | $204.17 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $199.53 / $1,778.28
| Professional | | $186.21 | $199.53 | $1,778.28 |
- 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 |