- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.00 / $9,686.42 / $26,503.52
| Facility | | $33.00 | $9,686.42 | $26,503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.96 / $39.56 / $14,544.00
| Professional | | $32.96 | $39.56 | $14,544.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.10 / $31.10 / $32.96
| Facility | | $31.10 | $31.10 | $32.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.96 / $32.96 / $32.96
| Professional | | $32.96 | $32.96 | $32.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.00 / $41.21 / $52.75
| Facility | | $33.00 | $41.21 | $52.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.96 / $34.94 / $41.20
| Professional | | $32.96 | $34.94 | $41.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.78 / $30.00 / $63.08
| Professional | | $23.78 | $30.00 | $63.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.51 / $42.66 / $79.00
| Facility | | $33.51 | $42.66 | $79.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $39.56 / $39.56
| Professional | | $36.26 | $39.56 | $39.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.96 / $32.96 / $34.94
| Professional | | $32.96 | $32.96 | $34.94 |