- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.03 / $29.23 / $38.97
| Professional | | $21.03 | $29.23 | $38.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.78 / $37.78 / $37.78
| Professional | | $37.78 | $37.78 | $37.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $36.74
| Facility | | $36.74 | $36.74 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.23 / $36.74 / $44.24
| Professional | | $31.23 | $36.74 | $44.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99,999.99 / $99,999.99 / $99,999.99
| Facility | | $99,999.99 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $49.03 / $57.51
| Professional | | $29.27 | $49.03 | $57.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.62 / $38.04 / $38.04
| Professional | | $26.62 | $38.04 | $38.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.49 / $27.62 / $39.49
| Professional | | $21.49 | $27.62 | $39.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.04 / $38.04 / $38.04
| Professional | | $38.04 | $38.04 | $38.04 |