- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $2,238.72
| Facility | | $32.36 | $32.36 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $32.36 / $52.48
| Professional | | $21.88 | $32.36 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $602.56 / $1,737.80
| Facility | | $323.59 | $602.56 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $524.81
| Facility | | $151.36 | $218.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $147.91 / $251.19
| Professional | | $81.28 | $147.91 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $208.93 / $407.38
| Facility | | $165.96 | $208.93 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $128.82 / $234.42
| Professional | | $77.62 | $128.82 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $93.33 / $1,949.84
| Facility | | $39.81 | $93.33 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $47.86 / $114.82
| Professional | | $28.18 | $47.86 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,862.09 / $3,715.35
| Facility | | $645.65 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $52.48 / $87.10
| Professional | | $29.51 | $52.48 | $87.10 |