- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.82 / $51.06 / $31,437.50
| Facility | | $20.82 | $51.06 | $31,437.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.70 / $16,424.65
| Professional | | $17.02 | $17.70 | $16,424.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.27 / $20.27 / $20.27
| Professional | | $20.27 | $20.27 | $20.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.62 / $50.84 / $89.08
| Facility | | $13.62 | $50.84 | $89.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.71 / $16.34 / $17.77
| Professional | | $15.71 | $16.34 | $17.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $17.02 / $17.02
| Facility | | $16.05 | $17.02 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $17.02
| Professional | | $17.02 | $17.02 | $17.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.51 / $19.32 / $33.36
| Facility | | $16.51 | $19.32 | $33.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $16.89 / $40.19
| Professional | | $16.89 | $16.89 | $40.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $18.04
| Professional | | $17.02 | $17.02 | $18.04 |