- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $52.48 / $7,943.28
| Facility | | $43.65 | $52.48 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $41.69 / $53.70
| Professional | | $31.62 | $41.69 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $27.54 / $52.48
| Facility | | $21.38 | $27.54 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $40.74 / $43.65
| Facility | | $34.67 | $40.74 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $30.20 / $50.12
| Facility | | $19.95 | $30.20 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $1,174.90
| Facility | | $707.95 | $1,000.00 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,071.52 / $5,128.61
| Facility | | $186.21 | $1,071.52 | $5,128.61 |