- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $3,467.37 / $9,549.93
| Facility | | $0.98 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,548.82 / $4,073.80
| Professional | | $389.05 | $1,548.82 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $602.56 / $630.96
| Facility | | $575.44 | $602.56 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $3,630.78
| Facility | | $1,230.27 | $1,862.09 | $3,630.78 |