- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.13 / $5.84 / $108.13
| Facility | | $3.13 | $5.84 | $108.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.16 / $67.06
| Professional | | $3.13 | $3.16 | $67.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.29 / $9.58 / $2,529.12
| Facility | | $6.29 | $9.58 | $2,529.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.29 / $502.47
| Professional | | $3.13 | $3.29 | $502.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.36 / $3.84 / $7.47
| Facility | | $3.36 | $3.84 | $7.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.52 / $5.13 / $6.81
| Professional | | $3.52 | $5.13 | $6.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.13
| Facility | | $3.13 | $3.13 | $3.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.22
| Professional | | $3.13 | $3.13 | $3.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $83.43 / $8,090.00
| Facility | | $3.72 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.13
| Professional | | $3.13 | $3.13 | $3.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.62
| Professional | | $3.13 | $3.13 | $3.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.08 / $21.98 / $154.41
| Facility | | $5.08 | $21.98 | $154.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.69 / $21.69 / $21.69
| Professional | | $21.69 | $21.69 | $21.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $2,529.12 / $2,529.12
| Facility | | $75.00 | $2,529.12 | $2,529.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.32 / $502.47
| Professional | | $3.13 | $3.32 | $502.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.18 / $95.93 / $115.31
| Facility | | $3.18 | $95.93 | $115.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $11.41
| Professional | | $3.13 | $3.13 | $11.41 |