- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.57 / $60.15 / $86.29
| Facility | | $30.57 | $60.15 | $86.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.57 / $32.28 / $53.31
| Professional | | $30.57 | $32.28 | $53.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,603.60 / $4,622.80 / $8,200.00
| Facility | | $3,603.60 | $4,622.80 | $8,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.25 / $35.25 / $35.25
| Professional | | $35.25 | $35.25 | $35.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Facility | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Professional | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.88 / $51.26 / $150.00
| Professional | | $35.88 | $51.26 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.17 / $38.61 / $41.00
| Professional | | $34.17 | $38.61 | $41.00 |