- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.58 / $11.58 / $14.48
| Facility | | $11.58 | $11.58 | $14.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $14.48 / $38.29
| Professional | | $11.58 | $14.48 | $38.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.00 / $57,255.43 / $79,506.39
| Facility | | $967.00 | $57,255.43 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $23.61 / $23.61
| Professional | | $23.61 | $23.61 | $23.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.67 / $27.67 / $27.67
| Facility | | $27.67 | $27.67 | $27.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $9.63 / $9.63
| Professional | | $9.63 | $9.63 | $9.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.79 / $31.97 / $34.22
| Professional | | $24.79 | $31.97 | $34.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.58 / $11.58 / $14.48
| Facility | | $11.58 | $11.58 | $14.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $14.56 / $38.29
| Professional | | $11.58 | $14.56 | $38.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.00 / $35.20 / $46.50
| Professional | | $29.00 | $35.20 | $46.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.67 / $27.67 / $27.67
| Facility | | $27.67 | $27.67 | $27.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $9.63 / $9.63
| Professional | | $9.63 | $9.63 | $9.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.83 / $22.48 / $22.48
| Facility | | $13.83 | $22.48 | $22.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.83 / $22.48 / $22.48
| Professional | | $13.83 | $22.48 | $22.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $11.78 / $19.64
| Professional | | $10.01 | $11.78 | $19.64 |