- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $57.54 / $81.28
| Professional | | $50.12 | $57.54 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $85.11 / $114.82
| Professional | | $0.02 | $85.11 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,230.27 / $1,230.27
| Facility | | $446.68 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $91.20 / $251.19
| Professional | | $54.95 | $91.20 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,398.83 / $5,495.41
| Facility | | $794.33 | $2,398.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $67.61 / $120.23
| Professional | | $48.98 | $67.61 | $120.23 |