- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.85 / $61.13 / $10,556.00
| Facility | | $43.85 | $61.13 | $10,556.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.16 / $42.58 / $52.70
| Professional | | $42.16 | $42.58 | $52.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.16 / $66.86 / $123.12
| Facility | | $42.16 | $66.86 | $123.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.16 / $42.16 / $42.16
| Professional | | $42.16 | $42.16 | $42.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.16 / $42.16 / $42.16
| Facility | | $42.16 | $42.16 | $42.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.16 / $42.16 / $42.16
| Professional | | $42.16 | $42.16 | $42.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.74 / $43.75 / $50.40
| Professional | | $41.74 | $43.75 | $50.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,659.40 / $10,659.40 / $10,659.40
| Facility | | $10,659.40 | $10,659.40 | $10,659.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.04 / $42.16 / $46.38
| Professional | | $40.04 | $42.16 | $46.38 |