- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.82 / $1,616.19 / $14,240.25
| Facility | | $34.82 | $1,616.19 | $14,240.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $28.14 / $6,342.30
| Professional | | $27.86 | $28.14 | $6,342.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $28.84 / $28.84
| Professional | | $27.86 | $28.84 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.73 / $28.73 / $71.17
| Facility | | $28.73 | $28.73 | $71.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $30.15
| Professional | | $27.86 | $27.86 | $30.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.68 / $27.86 / $37.88
| Professional | | $23.68 | $27.86 | $37.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $31.01 / $33.71
| Professional | | $27.86 | $31.01 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.73 / $28.73 / $38.95
| Professional | | $28.73 | $28.73 | $38.95 |