- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.84 / $2,700.96 / $7,119.04
| Facility | | $67.84 | $2,700.96 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.03 / $30.16 / $161.22
| Professional | | $20.03 | $30.16 | $161.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.40 / $47.43 / $1,026.00
| Facility | | $27.40 | $47.43 | $1,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.70 / $46.58 / $67.78
| Facility | | $33.70 | $46.58 | $67.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,607.00 / $1,966.00
| Facility | | $1,026.00 | $1,607.00 | $1,966.00 |