- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.00
| Facility | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $2.00 / $3.09
| Professional | | $1.00 | $2.00 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $3.39 / $79.43
| Facility | | $3.31 | $3.39 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $2.69 / $5.13
| Professional | | $1.35 | $2.69 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $2.34 / $7.24
| Facility | | $2.34 | $2.34 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $2.24 / $2.24
| Professional | | $2.19 | $2.24 | $2.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.91 / $2.09 / $2.09
| Facility | | $1.91 | $2.09 | $2.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.78 / $1.78 / $2.57
| Professional | | $1.78 | $1.78 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.02 / $4.68
| Professional | | $3.02 | $3.02 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $1.66 / $1.66
| Professional | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $3.39 / $79.43
| Facility | | $3.31 | $3.39 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $2.88 / $5.37
| Professional | | $1.38 | $2.88 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $2.24 / $2.34
| Professional | | $2.24 | $2.24 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.12 / $1.62 / $2.19
| Facility | | $1.12 | $1.62 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $2.00 / $3.31
| Professional | | $1.35 | $2.00 | $3.31 |