- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.61 / $25.61 / $16,429.06
| Facility | | $25.61 | $25.61 | $16,429.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.03 / $11.48 / $13.35
| Professional | | $11.03 | $11.48 | $13.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $13.41 / $34.99
| Facility | | $10.68 | $13.41 | $34.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $11.04 / $11.04
| Professional | | $11.04 | $11.04 | $11.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.04 / $11.04 / $11.04
| Facility | | $11.04 | $11.04 | $11.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $11.04 / $11.04
| Professional | | $11.04 | $11.04 | $11.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $11.04 / $13.37
| Professional | | $11.04 | $11.04 | $13.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.61 / $27.60 / $16,429.06
| Facility | | $25.61 | $27.60 | $16,429.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.03 / $12.07 / $16.32
| Professional | | $11.03 | $12.07 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $11.04 / $19.32
| Professional | | $11.04 | $11.04 | $19.32 |