- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.04 / $114.38 / $27,311.58
| Facility | | $34.04 | $114.38 | $27,311.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $34.04 / $34.04
| Professional | | $34.04 | $34.04 | $34.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $77.86 / $131.66
| Professional | | $34.04 | $77.86 | $131.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.11 / $32.11 / $34.04
| Facility | | $32.11 | $32.11 | $34.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.94 / $28.94 / $34.04
| Professional | | $28.94 | $28.94 | $34.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.99 / $34.04 / $55.19
| Professional | | $30.99 | $34.04 | $55.19 |