- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.20 / $2.20 / $2.20
| Facility | | $2.20 | $2.20 | $2.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.76 / $2.39 / $3.04
| Professional | | $1.76 | $2.39 | $3.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.78 / $4.16 / $6.88
| Facility | | $3.78 | $4.16 | $6.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $3.52 / $4.63
| Professional | | $3.27 | $3.52 | $4.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.72 / $4.54 / $8.09
| Facility | | $2.72 | $4.54 | $8.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $3.97 / $5.29
| Professional | | $3.78 | $3.97 | $5.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $9.91 / $15.40
| Facility | | $2.27 | $9.91 | $15.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $5.72 / $7.15
| Professional | | $1.93 | $5.72 | $7.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.04 / $3.28 / $4.34
| Facility | | $1.04 | $3.28 | $4.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $3.78 / $4.54
| Professional | | $2.16 | $3.78 | $4.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.84 / $3.96 / $80.00
| Facility | | $1.84 | $3.96 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.93 / $4.12
| Professional | | $1.48 | $1.93 | $4.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.01 / $55.00 / $85.00
| Professional | | $2.01 | $55.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.04 / $3.30 / $4.34
| Facility | | $1.04 | $3.30 | $4.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $3.78 / $4.54
| Professional | | $2.16 | $3.78 | $4.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $5.80 / $10.03
| Professional | | $3.78 | $5.80 | $10.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $7.38 / $80.00
| Facility | | $2.27 | $7.38 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $2.27 / $18.82
| Professional | | $1.93 | $2.27 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $3.78 / $3.78
| Professional | | $3.78 | $3.78 | $3.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $3.78 / $3.78
| Professional | | $3.78 | $3.78 | $3.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.88 / $3.14
| Professional | | $1.26 | $1.88 | $3.14 |