- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.18 / $2.44 / $4.73
| Facility | | $2.18 | $2.44 | $4.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $2.44 / $4.73
| Professional | | $1.37 | $2.44 | $4.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.88 / $2.88 / $2.88
| Professional | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $3.14 / $6.59
| Professional | | $2.50 | $3.14 | $6.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $4.17 / $4.17
| Facility | | $3.88 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.17 / $4.17 / $4.17
| Professional | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $3.01 / $3.19
| Facility | | $3.01 | $3.01 | $3.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $3.54
| Professional | | $2.56 | $2.56 | $3.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.00 / $11.25 / $332.00
| Facility | | $5.00 | $11.25 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.64 / $3.60 / $8.85
| Professional | | $2.64 | $3.60 | $8.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.56 / $3.56 / $3.56
| Facility | | $3.56 | $3.56 | $3.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.56 / $3.62 / $4.17
| Professional | | $3.56 | $3.62 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.36 / $3.36 / $3.36
| Professional | | $3.36 | $3.36 | $3.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.21 / $3.21 / $3.21
| Professional | | $3.21 | $3.21 | $3.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $3.01 / $555.00
| Facility | | $3.01 | $3.01 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.07 / $7.75
| Professional | | $2.56 | $3.07 | $7.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $2.50 / $4.30
| Professional | | $1.66 | $2.50 | $4.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.58 / $3.62 / $3.62
| Facility | | $3.58 | $3.62 | $3.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.56 / $3.62 / $3.62
| Professional | | $3.56 | $3.62 | $3.62 |