- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.38 / $109.46 / $19,596.00
| Facility | | $48.38 | $109.46 | $19,596.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $49.45 / $6,061.83
| Professional | | $47.53 | $49.45 | $6,061.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.49 / $49.91 / $151.62
| Facility | | $43.49 | $49.91 | $151.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $47.53 / $48.38
| Professional | | $47.53 | $47.53 | $48.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $49.30
| Facility | | $47.52 | $47.52 | $49.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $47.52
| Professional | | $47.52 | $47.52 | $47.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $51.56 / $116.55
| Professional | | $47.52 | $51.56 | $116.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.15 / $54.15 / $54.15
| Facility | | $54.15 | $54.15 | $54.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $47.52
| Professional | | $47.52 | $47.52 | $47.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $47.53 / $53.23
| Professional | | $47.53 | $47.53 | $53.23 |