- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $43.74 / $39,637.94
| Facility | | $17.01 | $43.74 | $39,637.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.01 / $17.02 / $39.38
| Professional | | $17.01 | $17.02 | $39.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.00 / $17.00 / $17.00
| Facility | | $17.00 | $17.00 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $17.02
| Professional | | $17.02 | $17.02 | $17.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.51 / $47.51 / $47.51
| Facility | | $47.51 | $47.51 | $47.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.17 / $18.04 / $25.53
| Professional | | $16.17 | $18.04 | $25.53 |