- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.32 / $5,008.50 / $24,897.50
| Facility | | $32.32 | $5,008.50 | $24,897.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $30.65 / $4,324.71
| Professional | | $27.86 | $30.65 | $4,324.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.77 / $32.47 / $37.35
| Facility | | $28.77 | $32.47 | $37.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $34.61 / $40.25
| Professional | | $27.86 | $34.61 | $40.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.09 / $57.19 / $77.14
| Facility | | $43.09 | $57.19 | $77.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.65 / $37.76 / $39.74
| Professional | | $30.65 | $37.76 | $39.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |