- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.67 / $10,742.79 / $26,506.86
| Facility | | $54.67 | $10,742.79 | $26,506.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.57 / $56.11 / $112.42
| Professional | | $55.57 | $56.11 | $112.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.66 / $54.66 / $55.57
| Professional | | $54.66 | $54.66 | $55.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.39 / $51.39 / $59.91
| Facility | | $51.39 | $51.39 | $59.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.57 / $55.57 / $65.53
| Professional | | $55.57 | $55.57 | $65.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.23 / $55.57 / $63.41
| Professional | | $47.23 | $55.57 | $63.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.57 / $61.86 / $67.23
| Professional | | $55.57 | $61.86 | $67.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.39 / $51.39 / $73.80
| Professional | | $51.39 | $51.39 | $73.80 |