- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.81 / $4.46 / $21.87
| Facility | | $2.81 | $4.46 | $21.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $3.87
| Professional | | $2.82 | $2.82 | $3.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $9.34 / $100.00
| Facility | | $2.63 | $9.34 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.96 / $40.61
| Professional | | $2.82 | $2.96 | $40.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $3.46 / $6.73
| Facility | | $3.02 | $3.46 | $6.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $2.82
| Facility | | $2.82 | $2.82 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $2.82
| Professional | | $2.82 | $2.82 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.36 / $53.00 / $8,090.00
| Facility | | $3.36 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $2.82
| Professional | | $2.82 | $2.82 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $3.26
| Professional | | $2.82 | $2.82 | $3.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.26 / $10.67 / $23.59
| Facility | | $1.26 | $10.67 | $23.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $6.76 / $6.76
| Professional | | $6.76 | $6.76 | $6.76 |
- 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
- $2.82 / $2.99 / $40.61
| Professional | | $2.82 | $2.99 | $40.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.87 / $2.06 / $3.10
| Facility | | $1.87 | $2.06 | $3.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.96 / $4.23
| Professional | | $2.82 | $2.96 | $4.23 |