- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $138.04 / $3,715.35
| Facility | | $32.36 | $138.04 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,737.80
| Professional | | $32.36 | $33.11 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $56.23 / $112.20
| Facility | | $35.48 | $56.23 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $30.90 / $42.66
| Facility | | $30.90 | $30.90 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $151.36 / $151.36
| Professional | | $45.71 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $30.90 / $33.11
| Professional | | $30.90 | $30.90 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |