- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $57.53 / $8,735.39
| Facility | | $0.98 | $57.53 | $8,735.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.49 / $1,385.50 / $7,404.23
| Professional | | $155.49 | $1,385.50 | $7,404.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,147.00 / $3,147.00 / $3,147.00
| Professional | | $3,147.00 | $3,147.00 | $3,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $507.00 / $641.21
| Facility | | $507.00 | $507.00 | $641.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.00 / $36.00 / $41.00
| Facility | | $36.00 | $36.00 | $41.00 |