- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.48 / $12.79 / $7,982.43
| Facility | | $12.48 | $12.79 | $7,982.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.48 / $12.79 / $13.26
| Professional | | $12.48 | $12.79 | $13.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.58 / $12.12 / $31.25
| Facility | | $7.58 | $12.12 | $31.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $7.58 / $7.58
| Professional | | $7.58 | $7.58 | $7.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.26 / $13.26 / $13.26
| Facility | | $13.26 | $13.26 | $13.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.26 / $13.26 / $13.26
| Professional | | $13.26 | $13.26 | $13.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $552.50 / $552.50
| Facility | | $80.00 | $552.50 | $552.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.41 / $1,391.41 / $1,391.41
| Professional | | $1,391.41 | $1,391.41 | $1,391.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.73 / $15.60 / $27.11
| Facility | | $12.73 | $15.60 | $27.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $11.92 / $28.76
| Professional | | $11.92 | $11.92 | $28.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.78 / $15.60 / $27.06
| Facility | | $12.78 | $15.60 | $27.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.26 / $13.26 / $13.26
| Professional | | $13.26 | $13.26 | $13.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $13.00 / $13.05
| Professional | | $13.00 | $13.00 | $13.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.78 / $12.78 / $17.25
| Professional | | $12.78 | $12.78 | $17.25 |