- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.55 / $1,927.29 / $10,598.82
| Facility | | $47.55 | $1,927.29 | $10,598.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.28 / $47.55 / $120.32
| Professional | | $43.28 | $47.55 | $120.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.42 / $47.55 / $47.55
| Facility | | $36.42 | $47.55 | $47.55 |
- 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
- $47.55 / $47.55 / $47.55
| Facility | | $47.55 | $47.55 | $47.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.78 / $47.55 / $47.55
| Professional | | $23.78 | $47.55 | $47.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.80 / $34.97 / $50.88
| Professional | | $31.80 | $34.97 | $50.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $50.40 / $52.93
| Professional | | $47.55 | $50.40 | $52.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.28 / $43.28 / $47.55
| Professional | | $43.28 | $43.28 | $47.55 |