- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $16.60
| Facility | | $10.96 | $10.96 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $15.49
| Professional | | $10.96 | $10.96 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $11.48
| Facility | | $10.96 | $10.96 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.31 / $10.96 / $50,118.72
| Facility | | $6.31 | $10.96 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $52.48
| Professional | | $10.96 | $10.96 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $12.59 / $28.84
| Facility | | $10.47 | $12.59 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $19.05
| Professional | | $10.47 | $10.47 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $5.75 / $6.03
| Facility | | $5.75 | $5.75 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $10.23 / $10.96
| Professional | | $5.75 | $10.23 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $50,118.72 / $75,857.76
| Facility | | $14.13 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $10.47 / $10.47
| Facility | | $9.77 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $11.48 / $15.49
| Professional | | $10.00 | $11.48 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $6.17 / $10.23
| Facility | | $5.75 | $6.17 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $10.23 / $10.96
| Professional | | $5.75 | $10.23 | $10.96 |