- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,238.72
| Facility | | $758.58 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $234.42 / $5,495.41
| Professional | | $47.86 | $234.42 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $977.24
| Facility | | $616.60 | $724.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $645.65 / $1,659.59
| Facility | | $251.19 | $645.65 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $1,380.38 / $2,238.72
| Professional | | $46.77 | $1,380.38 | $2,238.72 |