- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.45 / $26.35 / $11,853.78
| Facility | | $24.45 | $26.35 | $11,853.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $10.96 / $14.67
| Professional | | $10.53 | $10.96 | $14.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.36 / $11.72 / $33.40
| Facility | | $9.36 | $11.72 | $33.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.94
| Professional | | $10.54 | $10.54 | $10.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $85.00
| Facility | | $10.54 | $10.54 | $85.00 |
- 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 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.45 / $26.35 / $11,853.78
| Facility | | $24.45 | $26.35 | $11,853.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $10.96 / $14.67
| Professional | | $10.53 | $10.96 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $15.28
| Professional | | $10.54 | $10.54 | $15.28 |