- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.34 / $3,437.50 / $9,367.21
| Facility | | $22.34 | $3,437.50 | $9,367.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.34 / $25.53 / $25.53
| Professional | | $22.34 | $25.53 | $25.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.59 / $45.59 / $45.59
| Professional | | $45.59 | $45.59 | $45.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.94 / $34.94 / $34.94
| Professional | | $34.94 | $34.94 | $34.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.98 / $31.95 / $241.16
| Facility | | $22.98 | $31.95 | $241.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.39 / $24.71 / $36.61
| Professional | | $15.39 | $24.71 | $36.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.39 / $24.71 / $36.61
| Professional | | $15.39 | $24.71 | $36.61 |