- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.76 / $8.76 / $9.27
| Facility | | $8.76 | $8.76 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.68 / $9.27 / $11.96
| Professional | | $7.68 | $9.27 | $11.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.93 / $19.61 / $19.61
| Professional | | $14.93 | $19.61 | $19.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $11.23 / $19.61
| Facility | | $11.23 | $11.23 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $9.55 / $17.17
| Professional | | $9.55 | $9.55 | $17.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.04 / $19.61 / $37.26
| Professional | | $18.04 | $19.61 | $37.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.76 / $8.76 / $8.76
| Facility | | $8.76 | $8.76 | $8.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.68 / $9.27 / $13.55
| Professional | | $7.68 | $9.27 | $13.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.30 / $28.00 / $38.60
| Professional | | $24.30 | $28.00 | $38.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $11.23 / $19.61
| Facility | | $11.23 | $11.23 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $9.55 / $23.25
| Professional | | $9.55 | $9.55 | $23.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.02 / $18.66 / $18.66
| Facility | | $14.02 | $18.66 | $18.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.02 / $18.66 / $19.16
| Professional | | $14.02 | $18.66 | $19.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $11.77 / $17.14
| Professional | | $8.96 | $11.77 | $17.14 |