- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.14 / $43.71 / $6,552.12
| Facility | | $28.14 | $43.71 | $6,552.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $28.14 / $53.07
| Professional | | $27.86 | $28.14 | $53.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.85 / $28.85 / $53.56
| Professional | | $28.85 | $28.85 | $53.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.33 / $35.33 / $53.00
| Facility | | $35.33 | $35.33 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.33 / $35.33 / $36.04
| Professional | | $35.33 | $35.33 | $36.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.24 / $1,445.24 / $1,445.24
| Facility | | $1,445.24 | $1,445.24 | $1,445.24 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $25.07 / $27.86 / $36.46
| Professional | | $25.07 | $27.86 | $36.46 |