- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $1,318.26
| Facility | | $407.38 | $562.34 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $295.12 / $346.74
| Professional | | $3.98 | $295.12 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $1,071.52
| Facility | | $354.81 | $354.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.37 / $354.81
| Professional | | $3.98 | $5.37 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $5,248.07 / $43,651.58
| Facility | | $346.74 | $5,248.07 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $1,380.38
| Facility | | $234.42 | $234.42 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $407.38 / $512.86
| Professional | | $5.62 | $407.38 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $354.81 / $354.81
| Facility | | $162.18 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $354.81
| Professional | | $151.36 | $213.80 | $354.81 |