- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.09 / $4,704.00 / $8,728.00
| Facility | | $9.09 | $4,704.00 | $8,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $2.70 / $10.41
| Professional | | $2.16 | $2.70 | $10.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.78 / $22.75 / $26.42
| Facility | | $14.78 | $22.75 | $26.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $1.70 / $11.72
| Professional | | $1.58 | $1.70 | $11.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $22.09 / $23.83
| Professional | | $9.09 | $22.09 | $23.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $4.46 / $9.09
| Facility | | $2.70 | $4.46 | $9.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $9.09 / $12.27
| Professional | | $3.00 | $9.09 | $12.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.18 / $9.09 / $13.64
| Facility | | $8.18 | $9.09 | $13.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.30 / $4.46 / $14.78
| Facility | | $3.30 | $4.46 | $14.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $3.30 / $10.28
| Professional | | $2.47 | $3.30 | $10.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.00 / $8.46 / $14.87
| Facility | | $3.00 | $8.46 | $14.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $6.06 / $22.15
| Professional | | $2.25 | $6.06 | $22.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.26 / $3.71
| Professional | | $1.26 | $1.26 | $3.71 |