- 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
- $148.00 / $148.00 / $148.00
| Professional | | $148.00 | $148.00 | $148.00 |
- 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
- $10.75 / $17.28 / $39.69
| Professional | | $10.75 | $17.28 | $39.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.84 / $54.88 / $102.94
| Facility | | $36.84 | $54.88 | $102.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.22 / $25.22 / $25.22
| Professional | | $25.22 | $25.22 | $25.22 |
- 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
- $11.98 / $14.57 / $107.77
| Professional | | $11.98 | $14.57 | $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
- $12.30 / $17.05 / $55.80
| Professional | | $12.30 | $17.05 | $55.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.84 / $15.84 / $15.84
| Facility | | $15.84 | $15.84 | $15.84 |
- 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
- $10.75 / $17.28 / $39.69
| Professional | | $10.75 | $17.28 | $39.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $17.28 / $54.89
| Professional | | $10.68 | $17.28 | $54.89 |