- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.84 / $5,401.32 / $5,401.32
| Facility | | $48.84 | $5,401.32 | $5,401.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.27 / $39.71 / $6,240.00
| Professional | | $31.27 | $39.71 | $6,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.89 / $142.62 / $232.40
| Facility | | $38.89 | $142.62 | $232.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $29.37 / $39.65
| Professional | | $29.37 | $29.37 | $39.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Facility | | $31.27 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Professional | | $31.27 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.40 / $26.40 / $26.40
| Professional | | $26.40 | $26.40 | $26.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $31.27 / $31.27
| Facility | | $30.44 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Professional | | $31.27 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Professional | | $31.27 | $31.27 | $31.27 |