- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.71 / $28.38 / $6,110.33
| Facility | | $27.71 | $28.38 | $6,110.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.89 / $28.38
| Professional | | $23.65 | $23.89 | $28.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.63 / $25.63 / $25.63
| Facility | | $25.63 | $25.63 | $25.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $25.63 / $25.63
| Professional | | $24.00 | $25.63 | $25.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.31 / $23.65 / $23.65
| Facility | | $22.31 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.66
| Professional | | $23.65 | $23.65 | $23.66 |