- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,737.80 / $2,454.71
| Facility | | $676.08 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $426.58 / $933.25
| Professional | | $93.33 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $467.74
| Professional | | $0.02 | $0.02 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $257.04 / $831.76
| Facility | | $74.13 | $257.04 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $218.78 / $457.09
| Professional | | $91.20 | $218.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $117.49 / $147.91
| Professional | | $97.72 | $117.49 | $147.91 |