- 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
- $119.00 / $119.00 / $119.00
| Professional | | $119.00 | $119.00 | $119.00 |
- 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
- $21.66 / $52.96 / $95.95
| Facility | | $21.66 | $52.96 | $95.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $21.06 / $21.06
| Professional | | $21.06 | $21.06 | $21.06 |
- 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 / $19.82 / $107.77
| Professional | | $14.57 | $19.82 | $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
- $10.84 / $15.02 / $62.32
| Professional | | $10.84 | $15.02 | $62.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.27 / $16.27 / $143.19
| Facility | | $16.27 | $16.27 | $143.19 |
- 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 / $33.63
| Professional | | $10.68 | $17.28 | $33.63 |