- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.63 / $4.88 / $17.47
| Facility | | $4.63 | $4.88 | $17.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.96 / $4.88 / $11.83
| Professional | | $2.96 | $4.88 | $11.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $3.05 / $564.00
| Professional | | $0.02 | $3.05 | $564.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $4.76 / $4.76
| Facility | | $4.76 | $4.76 | $4.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.76 / $4.76 / $4.76
| Professional | | $4.76 | $4.76 | $4.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $3.15 / $26.06
| Facility | | $3.06 | $3.15 | $26.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,249.62 / $38,249.62 / $38,249.62
| Professional | | $38,249.62 | $38,249.62 | $38,249.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.83 / $51.83 / $51.83
| Professional | | $51.83 | $51.83 | $51.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.15 / $3.15 / $597.00
| Facility | | $3.15 | $3.15 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $3.58 / $8.64
| Professional | | $2.24 | $3.58 | $8.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.83 / $51.94 / $51.94
| Facility | | $51.83 | $51.94 | $51.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.83 / $51.83 / $51.94
| Professional | | $51.83 | $51.83 | $51.94 |