- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $17.01 / $8,865.59
| Facility | | $10.54 | $17.01 | $8,865.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $14.54
| Professional | | $10.54 | $10.54 | $14.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.14 / $31.46 / $100.00
| Facility | | $12.14 | $31.46 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.07 / $1,253.85
| Professional | | $10.54 | $11.07 | $1,253.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.30 / $12.94 / $25.15
| Facility | | $11.30 | $12.94 | $25.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.54
| Facility | | $10.54 | $10.54 | $13.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.81
| Professional | | $10.54 | $10.54 | $13.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.36 / $53.00 / $8,090.00
| Facility | | $12.36 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $12.20
| Professional | | $10.54 | $10.54 | $12.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.33 / $3,108.87 / $4,444.39
| Facility | | $604.33 | $3,108.87 | $4,444.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.17 / $1,253.85
| Professional | | $10.54 | $11.17 | $1,253.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.47 / $13.34 / $19.36
| Facility | | $9.47 | $13.34 | $19.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.17 / $15.81
| Professional | | $10.54 | $11.17 | $15.81 |