- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.02 / $18.38 / $26,046.72
| Facility | | $15.02 | $18.38 | $26,046.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.36 / $23.82
| Professional | | $17.02 | $17.36 | $23.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $33.60
| Professional | | $17.02 | $17.02 | $33.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.08 / $20.63 / $32.72
| Facility | | $13.08 | $20.63 | $32.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $16.05 / $17.02
| Facility | | $16.05 | $16.05 | $17.02 |
- 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
- $12.29 / $18.23 / $25.54
| Facility | | $12.29 | $18.23 | $25.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.42 / $16.89 / $21.25
| Professional | | $15.42 | $16.89 | $21.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $20.25
| Professional | | $17.02 | $17.02 | $20.25 |