- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.00 / $271.00 / $271.00
| Facility | | $271.00 | $271.00 | $271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $131.72 / $137.68
| Professional | | $106.45 | $131.72 | $137.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.07 / $47.30 / $75.94
| Professional | | $42.07 | $47.30 | $75.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,749.56 / $57,049.43 / $61,249.39
| Facility | | $43,749.56 | $57,049.43 | $61,249.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $50.00 / $60.00
| Professional | | $40.00 | $50.00 | $60.00 |