- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.72 / $89.08 / $24,504.00
| Facility | | $49.72 | $89.08 | $24,504.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $52.80 / $5,508.00
| Professional | | $47.53 | $52.80 | $5,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $47.52
| Professional | | $47.52 | $47.52 | $47.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.41 / $126.41 / $126.41
| Facility | | $126.41 | $126.41 | $126.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $47.53 / $153.05
| Professional | | $47.53 | $47.53 | $153.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.42 / $163.16 / $256.41
| Facility | | $74.42 | $163.16 | $256.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.06 / $163.16 / $384.61
| Facility | | $72.06 | $163.16 | $384.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $51.55
| Professional | | $47.52 | $47.52 | $51.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.23 / $71.30 / $142.59
| Professional | | $53.23 | $71.30 | $142.59 |