- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $4.00 / $90.81
| Facility | | $2.29 | $4.00 | $90.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.31 / $21.80
| Professional | | $2.29 | $2.31 | $21.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $7.59 / $486.39
| Facility | | $2.31 | $7.59 | $486.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.40 / $152.53
| Professional | | $2.29 | $2.40 | $152.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.45 / $2.81 / $5.46
| Facility | | $2.45 | $2.81 | $5.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $3.76 / $4.98
| Professional | | $2.73 | $3.76 | $4.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.29
| Facility | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.74
| Professional | | $2.29 | $2.29 | $2.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.73 / $83.43 / $8,090.00
| Facility | | $2.73 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.29
| Professional | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.65
| Professional | | $2.29 | $2.29 | $2.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.95 / $69.94 / $344.32
| Facility | | $16.95 | $69.94 | $344.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $486.39 / $486.39
| Facility | | $75.00 | $486.39 | $486.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.43 / $152.53
| Professional | | $2.29 | $2.43 | $152.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $2.46 / $3.02
| Facility | | $2.24 | $2.46 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.43 / $7.11
| Professional | | $2.29 | $2.43 | $7.11 |