- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.13 / $1.13 / $1.20
| Facility | | $1.13 | $1.13 | $1.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.20 / $1.57
| Professional | | $1.00 | $1.20 | $1.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.94 / $2.54 / $2.54
| Professional | | $1.94 | $2.54 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.08 / $2.08 / $2.54
| Facility | | $2.08 | $2.08 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $2.23
| Professional | | $1.77 | $1.77 | $2.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.54 / $4.83
| Professional | | $2.34 | $2.54 | $4.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.13 / $1.13 / $1.13
| Facility | | $1.13 | $1.13 | $1.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.20 / $1.75
| Professional | | $1.00 | $1.20 | $1.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.60 / $5.00
| Professional | | $3.20 | $3.60 | $5.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.08 / $2.08 / $2.54
| Facility | | $2.08 | $2.08 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $3.00
| Professional | | $1.77 | $1.77 | $3.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $2.42 / $2.42
| Facility | | $1.82 | $2.42 | $2.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $2.42 / $2.50
| Professional | | $1.82 | $2.42 | $2.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.91 / $1.54 / $1.77
| Facility | | $0.91 | $1.54 | $1.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.17 / $1.42 / $2.29
| Professional | | $1.17 | $1.42 | $2.29 |