- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $41.62 / $29,564.31
| Facility | | $23.65 | $41.62 | $29,564.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.63 / $23.65 / $26.01
| Professional | | $23.63 | $23.65 | $26.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.31 / $23.65 / $24.33
| Facility | | $22.31 | $23.65 | $24.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Facility | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $24.83
| Professional | | $23.65 | $23.65 | $24.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.63 / $23.63 / $23.65
| Professional | | $23.63 | $23.63 | $23.65 |