- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.96 / $1.96 / $1.96
| Facility | | $1.96 | $1.96 | $1.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $1.96 / $2.86
| Professional | | $1.89 | $1.96 | $2.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.32 / $6.57 / $13.84
| Professional | | $3.32 | $6.57 | $13.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.01 / $10.53 / $14.00
| Facility | | $9.01 | $10.53 | $14.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $4.76 / $6.90
| Professional | | $2.75 | $4.76 | $6.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.96 / $2.71 / $6.23
| Facility | | $1.96 | $2.71 | $6.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.67 / $2.67 / $2.67
| Professional | | $2.67 | $2.67 | $2.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.89 / $2.71 / $6.67
| Facility | | $1.89 | $2.71 | $6.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $2.65 / $28.27
| Professional | | $1.96 | $2.65 | $28.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $85.00
| Professional | | $50.00 | $70.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.96 / $2.71 / $6.23
| Facility | | $1.96 | $2.71 | $6.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.67 / $2.67 / $2.67
| Professional | | $2.67 | $2.67 | $2.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.70 / $7.71 / $10.24
| Professional | | $3.70 | $7.71 | $10.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.29 / $6.43 / $90.00
| Facility | | $6.29 | $6.43 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $17.10 / $28.27
| Professional | | $2.75 | $17.10 | $28.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $2.06 / $3.83
| Professional | | $1.81 | $2.06 | $3.83 |