- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.48 / $7.48 / $11.87
| Facility | | $7.48 | $7.48 | $11.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.45 / $9.35 / $14.35
| Professional | | $5.45 | $9.35 | $14.35 |
- 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
- $11.62 / $15.25 / $15.25
| Professional | | $11.62 | $15.25 | $15.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.78 / $10.78 / $21.02
| Facility | | $10.78 | $10.78 | $21.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $9.16 / $13.31
| Professional | | $9.16 | $9.16 | $13.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.88 / $15.93 / $21.57
| Professional | | $13.88 | $15.93 | $21.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.48 / $7.48 / $11.87
| Facility | | $7.48 | $7.48 | $11.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $9.35 / $15.36
| Professional | | $5.31 | $9.35 | $15.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.20 / $21.70 / $30.00
| Professional | | $11.20 | $21.70 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.78 / $10.78 / $21.02
| Facility | | $10.78 | $10.78 | $21.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $9.16 / $20.25
| Professional | | $9.16 | $9.16 | $20.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.91 / $14.52 / $14.52
| Facility | | $10.91 | $14.52 | $14.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $14.52 / $17.07
| Professional | | $10.91 | $14.52 | $17.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $7.86 / $13.32
| Professional | | $6.30 | $7.86 | $13.32 |