- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.18 / $1.18 / $1.18
| Facility | | $1.18 | $1.18 | $1.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.13 / $1.18 / $1.71
| Professional | | $1.13 | $1.18 | $1.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $4.54 / $9.33
| Professional | | $2.04 | $4.54 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.41 / $6.32 / $8.40
| Facility | | $5.41 | $6.32 | $8.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.87 / $2.31 / $4.13
| Professional | | $0.87 | $2.31 | $4.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.18 / $1.63 / $4.00
| Facility | | $1.18 | $1.63 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $1.60 / $1.60
| Professional | | $1.60 | $1.60 | $1.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.18 / $1.63 / $4.00
| Facility | | $1.18 | $1.63 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.18 / $1.58 / $17.67
| Professional | | $1.18 | $1.58 | $17.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.11 / $58.40 / $85.00
| Professional | | $7.11 | $58.40 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.18 / $1.63 / $4.00
| Facility | | $1.18 | $1.63 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $1.60 / $1.60
| Professional | | $1.60 | $1.60 | $1.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.22 / $4.63 / $6.15
| Professional | | $2.22 | $4.63 | $6.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.78 / $3.85 / $90.00
| Facility | | $3.78 | $3.85 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.87 / $1.73 / $17.67
| Professional | | $0.87 | $1.73 | $17.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.09 / $1.30 / $2.29
| Professional | | $1.09 | $1.30 | $2.29 |