- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.63 / $96.79 / $1,316.24
| Facility | | $0.63 | $96.79 | $1,316.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.63 / $301.75
| Professional | | $0.63 | $0.63 | $301.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $2.72 / $100.00
| Facility | | $1.58 | $2.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.66 / $1,046.63
| Professional | | $0.63 | $0.66 | $1,046.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.68 / $0.77 / $1.50
| Facility | | $0.68 | $0.77 | $1.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.71 / $1.02 / $1.37
| Professional | | $0.71 | $1.02 | $1.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $0.60
| Facility | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $0.68
| Professional | | $0.60 | $0.60 | $0.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.75 / $83.43 / $8,090.00
| Facility | | $0.75 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.63 / $0.63
| Professional | | $0.63 | $0.63 | $0.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.63 / $0.73
| Professional | | $0.63 | $0.63 | $0.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $112.90 / $879.78
| Facility | | $2.06 | $112.90 | $879.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $2.57
| Professional | | $2.57 | $2.57 | $2.57 |
- 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
- $0.63 / $0.67 / $1,046.63
| Professional | | $0.63 | $0.67 | $1,046.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.63 / $4.75
| Professional | | $0.63 | $0.63 | $4.75 |