- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.88 / $40.17 / $56.76
| Facility | | $23.88 | $40.17 | $56.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $23.88 / $34.04
| Professional | | $23.88 | $23.88 | $34.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.34 / $75.31 / $3,290.10
| Facility | | $53.34 | $75.31 | $3,290.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $25.07 / $1,372.11
| Professional | | $23.88 | $25.07 | $1,372.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.60 / $29.32 / $56.98
| Facility | | $25.60 | $29.32 | $56.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.88 / $23.88 / $60.82
| Facility | | $23.88 | $23.88 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $23.88 / $29.93
| Professional | | $23.88 | $23.88 | $29.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.19 / $59.20 / $8,090.00
| Facility | | $30.19 | $59.20 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $23.88 / $23.88
| Professional | | $23.88 | $23.88 | $23.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $23.88 / $27.64
| Professional | | $23.88 | $23.88 | $27.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $3,290.10 / $3,290.10
| Facility | | $75.00 | $3,290.10 | $3,290.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $25.31 / $1,372.11
| Professional | | $23.88 | $25.31 | $1,372.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $25.31 / $68.41
| Professional | | $23.88 | $25.31 | $68.41 |