- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.64 / $6,205.27 / $9,542.45
| Facility | | $64.64 | $6,205.27 | $9,542.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.85 / $28.14 / $38.26
| Professional | | $27.85 | $28.14 | $38.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.78 / $30.97 / $88.29
| Facility | | $24.78 | $30.97 | $88.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $28.90
| Professional | | $27.86 | $27.86 | $28.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $71.17
| Facility | | $27.86 | $27.86 | $71.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.64 / $69.65 / $6,205.27
| Facility | | $64.64 | $69.65 | $6,205.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.85 / $28.98 / $41.78
| Professional | | $27.85 | $28.98 | $41.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $40.40
| Professional | | $27.86 | $27.86 | $40.40 |