- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.49 / $42.52 / $28,343.40
| Facility | | $39.49 | $42.52 | $28,343.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.49 / $39.49 / $39.49
| Professional | | $39.49 | $39.49 | $39.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.63 / $59.42 / $70.84
| Facility | | $52.63 | $59.42 | $70.84 |
- 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
- $84.55 / $117.07 / $145.09
| Facility | | $84.55 | $117.07 | $145.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.35 / $34.04 / $34.04
| Professional | | $32.35 | $34.04 | $34.04 |