- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.93 / $1.00 / $2.04
| Facility | | $0.93 | $1.00 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $2.24
| Professional | | $1.00 | $1.00 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- 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
- $2.63 / $2.63 / $2.63
| Professional | | $2.63 | $2.63 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $1.58 / $4.17
| Facility | | $1.58 | $1.58 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $1.32 / $1.32
| Professional | | $1.32 | $1.32 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $3.89 / $5.75
| Professional | | $2.82 | $3.89 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $2.63 / $2.63
| Facility | | $2.63 | $2.63 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $1.86 / $2.63
| Professional | | $1.58 | $1.86 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.93 / $1.00 / $2.04
| Facility | | $0.93 | $1.00 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $2.88
| Professional | | $1.00 | $1.00 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.17 / $4.17 / $4.17
| Facility | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $3.89 / $5.25
| Professional | | $0.60 | $3.89 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $1.86 / $2.51
| Facility | | $1.41 | $1.86 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.29 / $1.86 / $2.51
| Professional | | $1.29 | $1.86 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.02 / $1.32 / $2.19
| Professional | | $1.02 | $1.32 | $2.19 |