- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $128.82 / $10,000.00
| Facility | | $120.23 | $128.82 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $64.57
| Professional | | $51.29 | $51.29 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $162.18
| Facility | | $50.12 | $60.26 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $53.70
| Professional | | $51.29 | $51.29 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $51.29 / $93.33
| Facility | | $48.98 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Professional | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $128.82 / $10,000.00
| Facility | | $120.23 | $128.82 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $52.48 / $93.33
| Professional | | $51.29 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $72.44
| Professional | | $51.29 | $51.29 | $72.44 |