- 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
- $142.00 / $142.00 / $142.00
| Professional | | $142.00 | $142.00 | $142.00 |
- 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 / $41.92
| Professional | | $11.52 | $17.28 | $41.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.08 / $54.88 / $95.95
| Facility | | $27.08 | $54.88 | $95.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.66 / $23.66 / $23.66
| Professional | | $23.66 | $23.66 | $23.66 |
- 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 / $27.26 / $107.77
| Professional | | $14.57 | $27.26 | $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
- $16.11 / $22.33 / $74.19
| Professional | | $16.11 | $22.33 | $74.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.49 / $30.75 / $136.91
| Facility | | $26.49 | $30.75 | $136.91 |
- 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 / $41.92
| Professional | | $10.77 | $17.28 | $41.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $17.28 / $40.92
| Professional | | $10.68 | $17.28 | $40.92 |