- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.55 / $3,038.85 / $6,232.52
| Facility | | $30.55 | $3,038.85 | $6,232.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $30.56 / $40.34
| Professional | | $29.37 | $30.56 | $40.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.43 / $35.69 / $93.11
| Facility | | $28.43 | $35.69 | $93.11 |
- 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
- $27.66 / $29.38 / $29.38
| Facility | | $27.66 | $29.38 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $35.58
| Professional | | $29.38 | $29.38 | $35.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.55 / $73.45 / $5,885.82
| Facility | | $30.55 | $73.45 | $5,885.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.67 / $30.56 / $44.17
| Professional | | $29.67 | $30.56 | $44.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $42.60
| Professional | | $29.38 | $29.38 | $42.60 |