- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.92 / $327.24 / $1,355.68
| Facility | | $65.92 | $327.24 | $1,355.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $2.75 / $3.24
| Professional | | $2.24 | $2.75 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $10.52 / $27.67
| Facility | | $7.76 | $10.52 | $27.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $2.67 / $8.41
| Professional | | $2.59 | $2.67 | $8.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $2.75
| Facility | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.92 / $708.34 / $11,041.14
| Facility | | $65.92 | $708.34 | $11,041.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $2.75 / $5.36
| Professional | | $2.69 | $2.75 | $5.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $2.70 / $3.92
| Professional | | $2.70 | $2.70 | $3.92 |