- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.80 / $104.35 / $7,019.13
| Facility | | $47.80 | $104.35 | $7,019.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.77 / $5,784.60
| Professional | | $45.31 | $45.77 | $5,784.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.46 / $47.58 / $144.54
| Facility | | $41.46 | $47.58 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $47.80
| Professional | | $45.31 | $45.31 | $47.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $46.46
| Facility | | $45.31 | $45.31 | $46.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $45.31
| Professional | | $45.31 | $45.31 | $45.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $49.16 / $104.76
| Professional | | $45.31 | $49.16 | $104.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.92 / $54.92 / $54.92
| Facility | | $54.92 | $54.92 | $54.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $45.31
| Professional | | $45.31 | $45.31 | $45.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $50.75
| Professional | | $45.31 | $45.31 | $50.75 |