- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.65 / $59.59 / $13,566.92
| Facility | | $36.65 | $59.59 | $13,566.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $35.40 / $46.76
| Professional | | $34.04 | $35.40 | $46.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.40 / $150.13 / $727.35
| Facility | | $54.40 | $150.13 | $727.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.04 / $34.04 / $34.04
| Facility | | $34.04 | $34.04 | $34.04 |
- 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
- $31.57 / $47.67 / $202.15
| Professional | | $31.57 | $47.67 | $202.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.27 / $44.27 / $44.27
| Professional | | $44.27 | $44.27 | $44.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.03 / $34.03 / $34.03
| Facility | | $34.03 | $34.03 | $34.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $34.04 / $61.29
| Professional | | $34.04 | $34.04 | $61.29 |