- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.01 / $27.77 / $33.88
| Facility | | $27.01 | $27.77 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.42 / $18.07 / $25.61
| Professional | | $12.42 | $18.07 | $25.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.04 / $21.59 / $26.36
| Professional | | $17.04 | $21.59 | $26.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.07 / $22.80 / $36.58
| Facility | | $14.07 | $22.80 | $36.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.21 / $23.28 / $28.46
| Professional | | $19.21 | $23.28 | $28.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.80 / $25.41 / $32.34
| Professional | | $22.80 | $25.41 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.42 / $472.21 / $603.75
| Facility | | $330.42 | $472.21 | $603.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.41 / $22.52 / $28.04
| Professional | | $18.41 | $22.52 | $28.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $8,244.00 / $9,193.00
| Facility | | $1,800.00 | $8,244.00 | $9,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.34 / $23.70 / $33.32
| Professional | | $16.34 | $23.70 | $33.32 |