- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.63 / $47.38 / $11,922.59
| Facility | | $23.63 | $47.38 | $11,922.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.89 / $30.25
| Professional | | $23.65 | $23.89 | $30.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.63 / $23.63 / $23.65
| Professional | | $23.63 | $23.63 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $30.12
| Professional | | $23.65 | $23.65 | $30.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.63 / $23.65 / $29.27
| Professional | | $21.63 | $23.65 | $29.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $25.07
| Professional | | $23.65 | $23.65 | $25.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.17 / $23.17 / $23.17
| Professional | | $23.17 | $23.17 | $23.17 |