- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $25.70 / $111.11
| Facility | | $1.75 | $25.70 | $111.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $2.40
| Professional | | $1.75 | $1.75 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.69 / $5.36 / $3,832.60
| Facility | | $3.69 | $5.36 | $3,832.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.84 / $553.08
| Professional | | $1.75 | $1.84 | $553.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.88 / $2.15 / $4.18
| Facility | | $1.88 | $2.15 | $4.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $2.87 / $3.81
| Professional | | $2.08 | $2.87 | $3.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $1.75
| Facility | | $1.75 | $1.75 | $1.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $1.82
| Professional | | $1.75 | $1.75 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.08 / $83.43 / $8,090.00
| Facility | | $2.08 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $1.75
| Professional | | $1.75 | $1.75 | $1.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $2.02
| Professional | | $1.75 | $1.75 | $2.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.83 / $41.18 / $109.01
| Facility | | $11.83 | $41.18 | $109.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $3,832.60 / $3,832.60
| Facility | | $75.00 | $3,832.60 | $3,832.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.86 / $553.08
| Professional | | $1.75 | $1.86 | $553.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.85 / $8.73 / $10.49
| Facility | | $2.85 | $8.73 | $10.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.86 / $5.43
| Professional | | $1.75 | $1.86 | $5.43 |