- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.63 / $7,564.26 / $12,928.26
| Facility | | $33.63 | $7,564.26 | $12,928.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $32.63 / $7,026.90
| Professional | | $29.37 | $32.63 | $7,026.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.72 / $27.72 / $29.38
| Facility | | $27.72 | $27.72 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.24 / $38.93 / $52.52
| Facility | | $23.24 | $38.93 | $52.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $36.72
| Professional | | $29.38 | $29.38 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.81 / $27.81 / $27.81
| Professional | | $27.81 | $27.81 | $27.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.38 / $36.11 / $62.89
| Facility | | $29.38 | $36.11 | $62.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.43 / $35.26 / $35.26
| Professional | | $32.43 | $35.26 | $35.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $32.71
| Professional | | $29.38 | $29.38 | $32.71 |