- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $10,715.19 / $26,302.68
| Facility | | $56.23 | $10,715.19 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $46.77 / $10,964.78
| Professional | | $30.20 | $46.77 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $51.29
| Professional | | $30.20 | $30.20 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $48.98 / $56.23
| Facility | | $28.18 | $48.98 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $27.54 / $27.54
| Professional | | $26.30 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $75.86
| Facility | | $30.20 | $30.20 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $102.33
| Professional | | $30.20 | $30.20 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $47.86 / $57.54
| Facility | | $37.15 | $47.86 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $57.54 / $64.57
| Facility | | $29.51 | $57.54 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $44.67 / $63.10
| Professional | | $31.62 | $44.67 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |