- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $33.78 / $26,862.36
| Facility | | $17.02 | $33.78 | $26,862.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.19 / $35.15
| Professional | | $17.02 | $17.19 | $35.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $27.09 / $51.82
| Facility | | $17.02 | $27.09 | $51.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $17.58
| Professional | | $17.02 | $17.02 | $17.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $17.02 / $17.02
| Facility | | $16.05 | $17.02 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $18.46
| Professional | | $17.02 | $17.02 | $18.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.53 / $20.25
| Professional | | $17.02 | $17.53 | $20.25 |