- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.07 / $6,825.00 / $25,532.30
| Facility | | $11.07 | $6,825.00 | $25,532.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $10.86 / $14.67
| Professional | | $10.53 | $10.86 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $13.06
| Professional | | $13.06 | $13.06 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.43 / $16.62 / $30.10
| Facility | | $9.43 | $16.62 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $15.48 / $19.45
| Professional | | $10.54 | $15.48 | $19.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.94 / $10.54 / $18.96
| Facility | | $9.94 | $10.54 | $18.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.43
| Professional | | $10.54 | $10.54 | $13.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.17 / $11.07 / $20.47
| Facility | | $9.17 | $11.07 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $9.17 / $24.57
| Professional | | $9.17 | $9.17 | $24.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $13.71 / $30.30
| Professional | | $11.06 | $13.71 | $30.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $11.17 / $12.65
| Professional | | $8.96 | $11.17 | $12.65 |