- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $776.25
| Facility | | $371.54 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $380.19
| Professional | | $371.54 | $371.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $602.56
| Professional | | $346.74 | $346.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $14,454.40 / $20,417.38
| Facility | | $7,413.10 | $14,454.40 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.98 / $1.07 / $5.37
| Professional | | $0.98 | $1.07 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.07 / $1.07
| Professional | | $1.07 | $1.07 | $1.07 |