- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.48
| Facility | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.95 / $1.48 / $2.42
| Professional | | $0.95 | $1.48 | $2.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $7.44 / $80.00
| Facility | | $2.27 | $7.44 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $2.27 / $3.31
| Professional | | $1.32 | $2.27 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $6.83
| Facility | | $2.29 | $2.29 | $6.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $2.40 / $2.40
| Professional | | $2.13 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.84 / $2.04 / $2.29
| Facility | | $1.84 | $2.04 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.80 / $3.75
| Professional | | $1.73 | $1.80 | $3.75 |
- 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
- $2.76 / $2.76 / $2.90
| Professional | | $2.76 | $2.76 | $2.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.60 / $3.60 / $3.60
| Facility | | $3.60 | $3.60 | $3.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.80 / $1.80 / $1.80
| Professional | | $1.80 | $1.80 | $1.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.88 / $80.00 / $80.00
| Facility | | $6.88 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.19 / $1.69 / $3.31
| Professional | | $1.19 | $1.69 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $2.16 / $2.27
| Professional | | $2.16 | $2.16 | $2.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.22 / $1.69 / $3.31
| Professional | | $1.22 | $1.69 | $3.31 |