- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $4,508.64
| Facility | | $40.65 | $40.65 | $4,508.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $35.57 / $2,165.40
| Professional | | $33.88 | $35.57 | $2,165.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.40 / $37.40 / $37.40
| Facility | | $37.40 | $37.40 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.03 / $37.40 / $37.40
| Professional | | $36.03 | $37.40 | $37.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $44.82 / $51.21
| Facility | | $33.88 | $44.82 | $51.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $78.55
| Professional | | $33.88 | $33.88 | $78.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.96 / $33.88 / $33.88
| Facility | | $31.96 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $36.75
| Professional | | $33.88 | $33.88 | $36.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.86 / $33.88 / $38.29
| Professional | | $32.86 | $33.88 | $38.29 |