- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.67 / $6.06 / $6.33
| Facility | | $2.67 | $6.06 | $6.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $2.67 / $6.33
| Professional | | $1.38 | $2.67 | $6.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.12 / $80.00 / $80.00
| Facility | | $4.12 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.91 / $4.12 / $347.55
| Professional | | $3.91 | $4.12 | $347.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.81 / $6.32 / $9.09
| Facility | | $3.81 | $6.32 | $9.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.81 / $6.32 / $9.09
| Professional | | $3.81 | $6.32 | $9.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $3.96 / $3.96
| Professional | | $3.24 | $3.96 | $3.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $4.59 / $5.18
| Facility | | $3.71 | $4.59 | $5.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.24 / $4.71 / $5.18
| Professional | | $4.24 | $4.71 | $5.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.91 / $4.12 / $7.63
| Facility | | $3.91 | $4.12 | $7.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.91 / $4.59 / $5.29
| Professional | | $3.91 | $4.59 | $5.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $4.00 / $4.71
| Professional | | $3.80 | $4.00 | $4.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.77 / $3.77 / $3.77
| Facility | | $3.77 | $3.77 | $3.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.90 / $2.40 / $3.81
| Professional | | $1.90 | $2.40 | $3.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $2.08 / $4.00
| Professional | | $2.08 | $2.08 | $4.00 |