- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.85 / $5,181.60 / $27,108.58
| Facility | | $28.85 | $5,181.60 | $27,108.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $34.83 / $6,342.30
| Professional | | $27.86 | $34.83 | $6,342.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.34 / $22.34 / $27.86
| Facility | | $22.34 | $22.34 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.85 / $34.83 / $48.76
| Facility | | $28.85 | $34.83 | $48.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $29.53 / $34.83
| Professional | | $27.86 | $29.53 | $34.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $30.00 / $58.15
| Professional | | $19.60 | $30.00 | $58.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.26 / $39.90 / $80.59
| Facility | | $29.26 | $39.90 | $80.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.43 / $33.43 / $34.83
| Professional | | $33.43 | $33.43 | $34.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $29.53
| Professional | | $27.86 | $27.86 | $29.53 |