- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.02 / $4,661.45 / $8,460.45
| Facility | | $23.02 | $4,661.45 | $8,460.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.02 / $52.71 / $2,400.00
| Professional | | $23.02 | $52.71 | $2,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.34 / $53.09 / $71.29
| Facility | | $30.34 | $53.09 | $71.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.61 / $18.61 / $30.34
| Professional | | $18.61 | $18.61 | $30.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.72 / $29.38 / $29.38
| Facility | | $27.72 | $29.38 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $37.51
| Professional | | $29.38 | $29.38 | $37.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.02 / $34.96 / $41.26
| Facility | | $23.02 | $34.96 | $41.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $14.32 / $14.32
| Professional | | $14.32 | $14.32 | $14.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.36 / $29.36 / $29.38
| Facility | | $29.36 | $29.36 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $31.14 / $38.19
| Professional | | $29.38 | $31.14 | $38.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $146.90
| Facility | | $75.00 | $100.00 | $146.90 |