- 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
- $110.00 / $110.00 / $110.00
| Professional | | $110.00 | $110.00 | $110.00 |
- 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 / $38.54
| Professional | | $11.52 | $17.28 | $38.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.36 / $54.88 / $95.95
| Facility | | $27.36 | $54.88 | $95.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.72 / $17.72 / $17.72
| Professional | | $17.72 | $17.72 | $17.72 |
- 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
- $5.00 / $6.93 / $44.99
| Professional | | $5.00 | $6.93 | $44.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.09 / $74.09 / $74.09
| Facility | | $74.09 | $74.09 | $74.09 |
- 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 / $38.54
| Professional | | $10.77 | $17.28 | $38.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $17.28 / $38.54
| Professional | | $5.00 | $17.28 | $38.54 |