- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.04
| Facility | | $0.02 | $0.02 | $0.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.00 / $123.00 / $123.00
| Professional | | $123.00 | $123.00 | $123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.56 / $135.76 / $135.76
| Facility | | $47.56 | $135.76 | $135.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $17.28 / $39.69
| Professional | | $11.52 | $17.28 | $39.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.28 / $52.96 / $95.95
| Facility | | $21.28 | $52.96 | $95.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $22.01 / $22.01
| Professional | | $22.01 | $22.01 | $22.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $0.99 / $1.65
| Facility | | $0.56 | $0.99 | $1.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.57 / $20.23 / $107.77
| Professional | | $14.57 | $20.23 | $107.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.54 / $34.54 / $40.64
| Professional | | $34.54 | $34.54 | $40.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.80 / $27.46 / $62.32
| Professional | | $19.80 | $27.46 | $62.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.56 / $135.76 / $135.76
| Facility | | $47.56 | $135.76 | $135.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.77 / $17.28 / $39.69
| Professional | | $10.77 | $17.28 | $39.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.77 / $11.97 / $14.36
| Facility | | $10.77 | $11.97 | $14.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $18.42 / $113.77
| Professional | | $11.52 | $18.42 | $113.77 |