- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,002.00 / $22,002.00 / $96,000.00
| Facility | | $22,002.00 | $22,002.00 | $96,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.28 / $28.43 / $151.79
| Professional | | $26.28 | $28.43 | $151.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.40 / $33.40 / $46.61
| Professional | | $33.40 | $33.40 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.03 / $42.45 / $82.98
| Professional | | $27.03 | $42.45 | $82.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.27 / $37.59 / $61.70
| Professional | | $28.27 | $37.59 | $61.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.63 / $33.21 / $57.44
| Professional | | $25.63 | $33.21 | $57.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.82 / $32.50 / $40.71
| Professional | | $21.82 | $32.50 | $40.71 |