- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $24.05 / $32.89
| Facility | | $10.40 | $24.05 | $32.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $28.91
| Professional | | $10.40 | $10.40 | $28.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $12.70 / $21.41
| Professional | | $12.70 | $12.70 | $21.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59,702.01 / $59,702.01 / $59,702.01
| Facility | | $59,702.01 | $59,702.01 | $59,702.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $11.05
| Facility | | $11.05 | $11.05 | $11.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $17.39
| Professional | | $11.05 | $11.05 | $17.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $11.05
| Facility | | $11.05 | $11.05 | $11.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $17.39
| Professional | | $11.05 | $11.05 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $50.00 / $50.00
| Professional | | $40.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $13.00 / $14.06
| Professional | | $13.00 | $13.00 | $14.06 |