- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.56 / $8,477.27 / $20,928.72
| Facility | | $1,264.56 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.92 / $55.18 / $96.50
| Professional | | $35.92 | $55.18 | $96.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.12 / $715.74 / $1,343.62
| Facility | | $528.12 | $715.74 | $1,343.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.59 / $83.67 / $112.70
| Professional | | $49.59 | $83.67 | $112.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.49 / $36.26 / $40.81
| Facility | | $30.49 | $36.26 | $40.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.61 / $107.61 / $107.61
| Professional | | $107.61 | $107.61 | $107.61 |