- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $3.02 / $3.02
| Facility | | $1.00 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $2.00 / $3.31
| Professional | | $1.00 | $2.00 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $3.89
| Professional | | $3.89 | $3.89 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $6.17
| Facility | | $2.29 | $2.29 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $1.95 / $2.45
| Professional | | $1.95 | $1.95 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $4.37 / $7.41
| Professional | | $2.24 | $4.37 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $3.89
| Facility | | $3.89 | $3.89 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.75 / $3.89
| Professional | | $2.34 | $2.75 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.88 / $2.88
| Professional | | $2.75 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $3.02
| Facility | | $1.00 | $1.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $2.00 / $3.63
| Professional | | $1.00 | $2.00 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.17 / $6.17 / $6.17
| Facility | | $6.17 | $6.17 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $5.25 / $7.59
| Professional | | $0.60 | $5.25 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $7.94
| Facility | | $2.75 | $2.75 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $3.63 / $7.94
| Professional | | $2.75 | $3.63 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.29 / $1.62 / $2.45
| Facility | | $1.29 | $1.62 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $1.91 / $3.47
| Professional | | $1.32 | $1.91 | $3.47 |