- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.94 / $2.18 / $4.21
| Facility | | $1.94 | $2.18 | $4.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $2.18 / $4.21
| Professional | | $1.21 | $2.18 | $4.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $6.63
| Professional | | $2.25 | $2.25 | $6.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.45 / $3.71 / $3.71
| Facility | | $3.45 | $3.71 | $3.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.71 / $3.71 / $3.71
| Professional | | $3.71 | $3.71 | $3.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $2.68 / $3.31
| Facility | | $2.68 | $2.68 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $3.31
| Professional | | $2.27 | $2.27 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.45 / $10.01 / $332.00
| Facility | | $4.45 | $10.01 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $3.34 / $8.14
| Professional | | $2.29 | $3.34 | $8.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.53 / $1.53 / $1.53
| Facility | | $1.53 | $1.53 | $1.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $2.58 / $3.20
| Professional | | $1.53 | $2.58 | $3.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $2.68 / $555.00
| Facility | | $2.68 | $2.68 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.76 / $6.09
| Professional | | $2.27 | $2.76 | $6.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $2.22 / $4.01
| Professional | | $1.48 | $2.22 | $4.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $2.58 / $2.58
| Facility | | $2.54 | $2.58 | $2.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $2.58 / $2.74
| Professional | | $1.53 | $2.58 | $2.74 |