- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.75 / $12,048.12 / $28,066.67
| Facility | | $35.75 | $12,048.12 | $28,066.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $35.75 / $57.42
| Professional | | $34.04 | $35.75 | $57.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $64.09 / $151.43
| Facility | | $32.36 | $64.09 | $151.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.48 / $34.38 / $86.30
| Professional | | $31.48 | $34.38 | $86.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.11 / $34.04 / $34.04
| Facility | | $32.11 | $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
- Facility
- Modifier
- Low / Median / High Price
- $35.75 / $44.59 / $126.92
| Facility | | $35.75 | $44.59 | $126.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.82 / $115.82 / $115.82
| Professional | | $115.82 | $115.82 | $115.82 |
- 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 / $34.04
| Professional | | $34.04 | $34.04 | $34.04 |