- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.04 / $4,577.85 / $10,075.01
| Facility | | $40.04 | $4,577.85 | $10,075.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.81
| Professional | | $12.32 | $12.32 | $12.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.35 / $12.35 / $13.05
| Facility | | $12.35 | $12.35 | $13.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.32
| Professional | | $12.32 | $12.32 | $12.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.62 / $12.32 / $12.32
| Facility | | $11.62 | $12.32 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.32
| Professional | | $12.32 | $12.32 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.32
| Professional | | $12.32 | $12.32 | $12.32 |