- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.11 / $1.11 / $1.11
| Facility | | $1.11 | $1.11 | $1.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.71 / $1.11 / $1.85
| Professional | | $0.71 | $1.11 | $1.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.71 / $5.14 / $80.00
| Facility | | $1.71 | $5.14 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.99 / $1.71 / $2.47
| Professional | | $0.99 | $1.71 | $2.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.63 / $1.63 / $4.84
| Facility | | $1.63 | $1.63 | $4.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $1.66 / $1.66
| Professional | | $1.50 | $1.66 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.38 / $1.52 / $3.00
| Facility | | $1.38 | $1.52 | $3.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.29 / $1.50 / $3.00
| Professional | | $1.29 | $1.50 | $3.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.06 / $2.17
| Professional | | $2.06 | $2.06 | $2.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.34 / $8.34 / $250.20
| Facility | | $8.34 | $8.34 | $250.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.39 / $1.39 / $1.39
| Professional | | $1.39 | $1.39 | $1.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.14 / $80.00 / $80.00
| Facility | | $5.14 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.84 / $1.27 / $3.45
| Professional | | $0.84 | $1.27 | $3.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $1.61 / $1.71
| Professional | | $1.61 | $1.61 | $1.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.84 / $1.27 / $2.41
| Professional | | $0.84 | $1.27 | $2.41 |