- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $40.51 / $28,016.44
| Facility | | $17.02 | $40.51 | $28,016.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $17.02 / $22.30
| Professional | | $16.89 | $17.02 | $22.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $16.89 / $29.56
| Professional | | $16.89 | $16.89 | $29.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $17.02 / $20.23
| Facility | | $16.05 | $17.02 | $20.23 |
- 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
- $17.02 / $17.02 / $17.02
| Facility | | $17.02 | $17.02 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $17.02 / $17.02
| Professional | | $8.51 | $17.02 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.38 / $209.42 / $304.61
| Professional | | $190.38 | $209.42 | $304.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $18.04 / $18.78
| Professional | | $17.02 | $18.04 | $18.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $16.89 / $17.02
| Professional | | $16.89 | $16.89 | $17.02 |