- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.45 / $4.75 / $5.81
| Facility | | $2.45 | $4.75 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $2.45 / $4.24
| Professional | | $1.27 | $2.45 | $4.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $4.05 / $4.33
| Professional | | $2.58 | $4.05 | $4.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.68 / $90.00 / $90.00
| Facility | | $3.68 | $90.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.03 / $3.79 / $31.73
| Professional | | $3.03 | $3.79 | $31.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $3.21
| Professional | | $1.77 | $1.77 | $3.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.48 / $4.61 / $10.31
| Facility | | $2.48 | $4.61 | $10.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $4.58 / $10.31
| Professional | | $2.48 | $4.58 | $10.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.33 / $4.33 / $75.00
| Professional | | $4.33 | $4.33 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.44 / $4.23 / $4.33
| Facility | | $3.44 | $4.23 | $4.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $4.33 / $4.33
| Professional | | $3.78 | $4.33 | $4.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.60 / $3.79 / $3.79
| Facility | | $3.60 | $3.79 | $3.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.60 / $4.23 / $4.86
| Professional | | $3.60 | $4.23 | $4.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.46 / $3.68 / $4.76
| Professional | | $3.46 | $3.68 | $4.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.84 / $3.50
| Professional | | $1.70 | $1.84 | $3.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $2.12
| Professional | | $2.12 | $2.12 | $2.12 |