- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $8.00 / $8.00
| Professional | | $8.00 | $8.00 | $8.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.09 / $846.65 / $1,432.46
| Facility | | $711.09 | $846.65 | $1,432.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $729.62 / $729.62
| Professional | | $2.02 | $729.62 | $729.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $100.00 / $1,735.41
| Facility | | $87.10 | $100.00 | $1,735.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $21.00 / $21.00
| Professional | | $21.00 | $21.00 | $21.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.00 / $393.93 / $801.00
| Professional | | $127.00 | $393.93 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $100.00 / $100.00
| Facility | | $65.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Professional | | $85.00 | $85.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.00 / $8.00 / $17.92
| Facility | | $8.00 | $8.00 | $17.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $21.00 / $21.00
| Professional | | $21.00 | $21.00 | $21.00 |