- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $4,786.30 / $7,079.46
| Facility | | $331.13 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $676.08
| Professional | | $144.54 | $234.42 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $436.52 / $2,137.96
| Facility | | $251.19 | $436.52 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $489.78
| Professional | | $257.04 | $354.81 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,548.13
| Facility | | $1,148.15 | $1,621.81 | $3,548.13 |