- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.67 / $55.98 / $3,771.60
| Facility | | $29.67 | $55.98 | $3,771.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $30.62 / $33.86
| Professional | | $30.32 | $30.62 | $33.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.35 / $53.75 / $97.02
| Facility | | $33.35 | $53.75 | $97.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $30.32 / $30.32
| Professional | | $30.32 | $30.32 | $30.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.58 / $23.58 / $23.58
| Facility | | $23.58 | $23.58 | $23.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $30.32 / $30.32
| Professional | | $30.32 | $30.32 | $30.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.93 / $40.98 / $370.60
| Facility | | $28.93 | $40.98 | $370.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.74 / $33.36 / $49.72
| Professional | | $22.74 | $33.36 | $49.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $30.32 / $30.32
| Professional | | $30.32 | $30.32 | $30.32 |