- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,981.07 / $11,220.18
| Facility | | $575.44 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $1,258.93
| Professional | | $363.08 | $562.34 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,023.29 / $6,025.60
| Facility | | $501.19 | $1,023.29 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,071.52
| Professional | | $758.58 | $891.25 | $1,071.52 |
- 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 |