- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $32.86 / $16,380.78
| Facility | | $23.65 | $32.86 | $16,380.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $24.59 / $6,687.00
| Professional | | $23.65 | $24.59 | $6,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.06 / $63.38 / $118.25
| Facility | | $21.06 | $63.38 | $118.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $29.92
| Professional | | $23.65 | $23.65 | $29.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.38 / $30.18 / $64.33
| Facility | | $25.38 | $30.18 | $64.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Facility | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $23.65
| Professional | | $23.65 | $23.65 | $23.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.10 / $53.00 / $8,090.00
| Facility | | $24.10 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $49.12
| Professional | | $23.65 | $23.65 | $49.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,642.73 / $18,642.73 / $18,642.73
| Facility | | $18,642.73 | $18,642.73 | $18,642.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $118.25
| Facility | | $75.00 | $75.00 | $118.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $35.47
| Professional | | $23.65 | $23.65 | $35.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $23.65 / $33.11
| Professional | | $23.65 | $23.65 | $33.11 |