- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.02 / $48.89 / $14,705.52
| Facility | | $22.02 | $48.89 | $14,705.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.24 / $3,374.35
| Professional | | $22.02 | $22.24 | $3,374.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.30 / $23.89 / $8,639.91
| Facility | | $20.30 | $23.89 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.85 / $22.85 / $22.85
| Professional | | $22.85 | $22.85 | $22.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.77 / $22.02 / $22.02
| Facility | | $20.77 | $22.02 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $22.02
| Professional | | $22.02 | $22.02 | $22.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.22 / $41.48 / $64.43
| Facility | | $35.22 | $41.48 | $64.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.14 / $52.11 / $14,705.52
| Facility | | $19.14 | $52.11 | $14,705.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.14 / $24.08 / $2,408.00
| Professional | | $19.14 | $24.08 | $2,408.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.77 / $22.02 / $22.02
| Facility | | $20.77 | $22.02 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $22.02
| Professional | | $22.02 | $22.02 | $22.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.71 / $22.71 / $26.36
| Facility | | $22.71 | $22.71 | $26.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.71 / $22.71 / $26.36
| Professional | | $22.71 | $22.71 | $26.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $22.02 / $37.26
| Professional | | $22.02 | $22.02 | $37.26 |