- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.56 / $2,640.09 / $9,822.53
| Facility | | $29.56 | $2,640.09 | $9,822.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $28.70 / $2,637.60
| Professional | | $27.86 | $28.70 | $2,637.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.82 / $29.82 / $29.82
| Professional | | $29.82 | $29.82 | $29.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.86 / $37.61 / $100.07
| Facility | | $27.86 | $37.61 | $100.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $28.11 / $35.38
| Professional | | $27.86 | $28.11 | $35.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.34 / $27.86 / $33.71
| Facility | | $22.34 | $27.86 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $30.15
| Professional | | $27.86 | $27.86 | $30.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.85 / $40.39 / $86.52
| Facility | | $28.85 | $40.39 | $86.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.85 / $30.58 / $126.83
| Professional | | $28.85 | $30.58 | $126.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.02 / $28.64 / $38.89
| Professional | | $27.02 | $28.64 | $38.89 |