- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.63 / $23.65 / $18,144.27
| Facility | | $23.63 | $23.65 | $18,144.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $26.27
| Professional | | $23.65 | $23.65 | $26.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.77 / $27.89 / $47.30
| Facility | | $26.77 | $27.89 | $47.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.10 / $23.65 / $23.65
| Professional | | $20.10 | $23.65 | $23.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $26.02 / $37.84
| Facility | | $23.65 | $26.02 | $37.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $24.83 / $33.26
| Professional | | $23.65 | $24.83 | $33.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.13 / $23.65 / $23.65
| Facility | | $23.13 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $43.24 / $43.24
| Professional | | $23.65 | $43.24 | $43.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |