- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $27.02 / $43,696.80
| Facility | | $17.02 | $27.02 | $43,696.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.05 / $62.00
| Professional | | $17.02 | $17.05 | $62.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.44 / $50.80 / $85.10
| Facility | | $14.44 | $50.80 | $85.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $4,929.21
| Professional | | $17.02 | $17.02 | $4,929.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.25 / $20.90 / $40.61
| Facility | | $18.25 | $20.90 | $40.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.27 / $27.91 / $35.35
| Professional | | $20.27 | $27.91 | $35.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.19 / $17.02 / $17.02
| Facility | | $16.19 | $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
- $17.23 / $53.00 / $8,090.00
| Facility | | $17.23 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $17.02
| Professional | | $17.02 | $17.02 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $19.70
| Professional | | $17.02 | $17.02 | $19.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,950.20 / $12,085.09 / $17,393.89
| Facility | | $8,950.20 | $12,085.09 | $17,393.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $85.10 / $85.10
| Facility | | $75.00 | $85.10 | $85.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $18.04 / $4,929.21
| Professional | | $17.02 | $18.04 | $4,929.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $17.02 / $20.95
| Professional | | $17.02 | $17.02 | $20.95 |