- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.61 / $21.25 / $17,967.06
| Facility | | $18.61 | $21.25 | $17,967.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $20.32 / $22.51
| Professional | | $13.77 | $20.32 | $22.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.70 / $19.39 / $19.39
| Professional | | $18.70 | $19.39 | $19.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.25 / $21.25 / $17,967.06
| Facility | | $21.25 | $21.25 | $17,967.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.27 / $20.16 / $22.51
| Professional | | $14.27 | $20.16 | $22.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.50 / $32.50 / $32.50
| Professional | | $32.50 | $32.50 | $32.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |