- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.09 / $4,808.13 / $6,742.51
| Facility | | $51.09 | $4,808.13 | $6,742.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $22.90 / $24.46
| Professional | | $22.01 | $22.90 | $24.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.31 / $26.75 / $69.78
| Facility | | $21.31 | $26.75 | $69.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $22.02
| Professional | | $22.02 | $22.02 | $22.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $22.02
| Facility | | $22.02 | $22.02 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $22.02
| Professional | | $22.02 | $22.02 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $26.67
| Professional | | $22.02 | $22.02 | $26.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.09 / $55.05 / $6,436.82
| Facility | | $51.09 | $55.05 | $6,436.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $22.90 / $30.24
| Professional | | $22.01 | $22.90 | $30.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $38.54
| Professional | | $22.02 | $22.02 | $38.54 |