- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $891.25 / $2,398.83
| Facility | | $0.98 | $891.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,778.28 / $2,511.89
| Facility | | $524.81 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | 22 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $602.56
| Professional | | $275.42 | $363.08 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,071.52 / $2,511.89
| Facility | | $724.44 | $1,071.52 | $2,511.89 |