- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.07 / $3,266.14 / $9,378.41
| Facility | | $12.07 | $3,266.14 | $9,378.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.55 / $16.57
| Professional | | $12.07 | $12.55 | $16.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.80 / $32.35 / $85.00
| Facility | | $9.80 | $32.35 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $15.27
| Professional | | $12.07 | $12.07 | $15.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.95 / $15.40 / $32.83
| Facility | | $12.95 | $15.40 | $32.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $12.07
| Facility | | $12.07 | $12.07 | $12.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $12.07
| Professional | | $12.07 | $12.07 | $12.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.24 / $53.00 / $8,090.00
| Facility | | $12.24 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $25.07
| Professional | | $12.07 | $12.07 | $25.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.12 / $4,285.16 / $10,015.07
| Facility | | $1,683.12 | $4,285.16 | $10,015.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $85.00
| Facility | | $75.00 | $75.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $18.11
| Professional | | $12.07 | $12.07 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.86 / $12.07 / $16.89
| Professional | | $10.86 | $12.07 | $16.89 |