- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.55 / $86.56 / $6,391.80
| Facility | | $47.55 | $86.56 | $6,391.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $48.02 / $2,275.67
| Professional | | $47.55 | $48.02 | $2,275.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.59 / $81.79 / $152.16
| Facility | | $51.59 | $81.79 | $152.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $47.55 / $47.55
| Professional | | $47.55 | $47.55 | $47.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.97 / $41.89 / $58.64
| Facility | | $36.97 | $41.89 | $58.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $47.55 / $47.55
| Professional | | $47.55 | $47.55 | $47.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.28 / $50.40 / $85.59
| Facility | | $43.28 | $50.40 | $85.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.83 / $52.30 / $71.80
| Professional | | $51.83 | $52.30 | $71.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $47.55 / $50.40
| Professional | | $47.55 | $47.55 | $50.40 |