- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.38 / $1,363.78 / $6,536.16
| Facility | | $29.38 | $1,363.78 | $6,536.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $32.90 / $4,211.62
| Professional | | $29.37 | $32.90 | $4,211.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.87 / $50.53 / $94.02
| Facility | | $31.87 | $50.53 | $94.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.72 / $27.72 / $37.93
| Facility | | $27.72 | $27.72 | $37.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.03 / $31.14 / $48.73
| Facility | | $28.03 | $31.14 | $48.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.04 / $32.32 / $48.18
| Professional | | $22.04 | $32.32 | $48.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |