- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.32 / $10,707.18 / $40,634.39
| Facility | | $55.32 | $10,707.18 | $40,634.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $17.70
| Professional | | $17.02 | $17.02 | $17.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.57 / $16.89 / $17.85
| Facility | | $16.57 | $16.89 | $17.85 |
- 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
- $17.02 / $17.02 / $17.02
| Professional | | $17.02 | $17.02 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $18.95
| Professional | | $17.02 | $17.02 | $18.95 |