- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.28 / $67.12 / $16,607.70
| Facility | | $36.28 | $67.12 | $16,607.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $36.28 / $47.86
| Professional | | $36.26 | $36.28 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $36.26 / $36.26
| Professional | | $36.26 | $36.26 | $36.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.22 / $36.28 / $37.21
| Facility | | $34.22 | $36.28 | $37.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.28 / $36.28 / $36.28
| Professional | | $36.28 | $36.28 | $36.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.28 / $36.28 / $36.28
| Facility | | $36.28 | $36.28 | $36.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.17 / $38.33 / $38.33
| Professional | | $19.17 | $38.33 | $38.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.01 / $37.73 / $56.60
| Professional | | $25.01 | $37.73 | $56.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.28 / $38.46 / $40.27
| Professional | | $36.28 | $38.46 | $40.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $36.26 / $36.28
| Professional | | $36.26 | $36.26 | $36.28 |