- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.99 / $12.28 / $17,097.12
| Facility | | $11.99 | $12.28 | $17,097.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.27 / $12.28 / $14.51
| Professional | | $12.27 | $12.28 | $14.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.91 / $14.49 / $24.56
| Facility | | $13.91 | $14.49 | $24.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $12.28
| Professional | | $12.28 | $12.28 | $12.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.28 / $14.74 / $19.64
| Facility | | $12.28 | $14.74 | $19.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $13.51 / $18.91
| Professional | | $12.28 | $13.51 | $18.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.28 / $26.52 / $26.52
| Facility | | $12.28 | $26.52 | $26.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $17.52
| Professional | | $12.28 | $12.28 | $17.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $14.20 / $18.46
| Professional | | $12.28 | $14.20 | $18.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $13.02 / $13.75
| Professional | | $12.28 | $13.02 | $13.75 |