- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $3.37
| Facility | | $2.12 | $2.12 | $3.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $2.12 / $3.58
| Professional | | $1.27 | $2.12 | $3.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $3.03 / $7.05
| Professional | | $2.17 | $3.03 | $7.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.82 / $4.33 / $4.33
| Professional | | $3.82 | $4.33 | $4.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $6.76 / $6.76
| Facility | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $3.21
| Professional | | $1.77 | $1.77 | $3.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $4.33 / $6.50
| Professional | | $0.11 | $4.33 | $6.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.92 / $2.92 / $3.25
| Professional | | $2.92 | $2.92 | $3.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $3.37
| Facility | | $2.12 | $2.12 | $3.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $2.12 / $6.00
| Professional | | $1.27 | $2.12 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $6.50 / $8.50
| Professional | | $5.40 | $6.50 | $8.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $6.76 / $6.76
| Facility | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $4.88
| Professional | | $1.77 | $1.77 | $4.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.10 / $4.12 / $4.12
| Facility | | $3.10 | $4.12 | $4.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.10 / $4.12 / $4.12
| Professional | | $3.10 | $4.12 | $4.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $2.16 / $3.90
| Professional | | $1.65 | $2.16 | $3.90 |