- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $4,677.35 / $7,413.10
| Facility | | $0.98 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $354.81 / $1,513.56
| Professional | | $74.13 | $354.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $645.65
| Facility | | $512.86 | $512.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $40.74 / $128.82
| Facility | | $36.31 | $40.74 | $128.82 |