- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.05 / $59.57 / $27,938.88
| Facility | | $17.05 | $59.57 | $27,938.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.05 / $20.44
| Professional | | $17.02 | $17.05 | $20.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $16.89 / $16.89
| Professional | | $16.89 | $16.89 | $16.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $34.04 / $41.19
| Facility | | $17.02 | $34.04 | $41.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $23.48
| Professional | | $17.02 | $17.02 | $23.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.89 / $17.02 / $25.53
| Facility | | $16.89 | $17.02 | $25.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $21.28
| Professional | | $17.02 | $17.02 | $21.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $21.05
| Facility | | $17.02 | $17.02 | $21.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $19.26
| Professional | | $17.02 | $17.02 | $19.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $18.04 / $19.47
| Professional | | $17.02 | $18.04 | $19.47 |