- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.45 / $4.45 / $5,030.60
| Facility | | $4.45 | $4.45 | $5,030.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.45 / $6.11
| Professional | | $4.45 | $4.45 | $6.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.08 / $13.28 / $100.00
| Facility | | $4.08 | $13.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.67 / $1,033.47
| Professional | | $4.45 | $4.67 | $1,033.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $5.46 / $10.62
| Facility | | $4.76 | $5.46 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.92 / $4.92 / $4.92
| Professional | | $4.92 | $4.92 | $4.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.28 / $4.45 / $4.45
| Facility | | $4.28 | $4.45 | $4.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.45 / $4.45
| Professional | | $4.45 | $4.45 | $4.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.19 / $53.00 / $8,090.00
| Facility | | $5.19 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.45 / $4.45
| Professional | | $4.45 | $4.45 | $4.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.45 / $5.15
| Professional | | $4.45 | $4.45 | $5.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.44 / $1,084.43 / $1,495.32
| Facility | | $498.44 | $1,084.43 | $1,495.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.72 / $1,033.47
| Professional | | $4.45 | $4.72 | $1,033.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $4.70 / $6.34
| Professional | | $4.45 | $4.70 | $6.34 |