- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.59 / $3.61 / $3.77
| Facility | | $1.59 | $3.61 | $3.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.85 / $1.59 / $3.77
| Professional | | $0.85 | $1.59 | $3.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.46 / $80.00 / $80.00
| Facility | | $2.46 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.33 / $2.46 / $20.55
| Professional | | $2.33 | $2.46 | $20.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.44 / $1.44 / $1.44
| Professional | | $1.44 | $1.44 | $1.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $3.48 / $5.30
| Facility | | $1.82 | $3.48 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $3.48 / $5.30
| Professional | | $1.82 | $3.48 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.94 / $2.16 / $60.00
| Professional | | $1.94 | $2.16 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $2.74 / $3.09
| Facility | | $2.24 | $2.74 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.81 / $3.23
| Professional | | $2.52 | $2.81 | $3.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.33 / $2.46 / $4.54
| Facility | | $2.33 | $2.46 | $4.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.33 / $2.74 / $3.15
| Professional | | $2.33 | $2.74 | $3.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.39 / $2.81
| Professional | | $2.27 | $2.39 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $2.25
| Facility | | $2.25 | $2.25 | $2.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.43 / $2.27
| Professional | | $1.12 | $1.43 | $2.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.27 / $2.39
| Professional | | $1.27 | $1.27 | $2.39 |