- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.57 / $62.63 / $35,645.40
| Facility | | $45.57 | $62.63 | $35,645.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.54 / $22.54 / $24.79
| Professional | | $22.54 | $22.54 | $24.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.21 / $22.21 / $25.98
| Professional | | $22.21 | $22.21 | $25.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.26 / $21.26 / $22.54
| Facility | | $21.26 | $21.26 | $22.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.54 / $22.54 / $27.81
| Professional | | $22.54 | $22.54 | $27.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.16 / $20.88 / $23.49
| Professional | | $19.16 | $20.88 | $23.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.54 / $25.09 / $26.82
| Professional | | $22.54 | $25.09 | $26.82 |