- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.22 / $5.56 / $6.00
| Facility | | $4.22 | $5.56 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.69 / $5.56 / $7.41
| Professional | | $3.69 | $5.56 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.41 / $9.50 / $23.23
| Facility | | $6.41 | $9.50 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.03 / $4.03 / $4.03
| Professional | | $4.03 | $4.03 | $4.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.08 / $5.08 / $9.91
| Facility | | $5.08 | $5.08 | $9.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.32 / $4.32 / $4.32
| Professional | | $4.32 | $4.32 | $4.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.17 / $80.00 / $85.00
| Facility | | $17.17 | $80.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.13 / $42.13 / $63.45
| Professional | | $42.13 | $42.13 | $63.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.56 / $6.68 / $10.56
| Facility | | $5.56 | $6.68 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $8.03 / $8.46
| Professional | | $6.42 | $8.03 | $8.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.20 / $9.73 / $16.70
| Professional | | $6.20 | $9.73 | $16.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.63 / $6.68 / $10.62
| Facility | | $5.63 | $6.68 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.32 / $4.32 / $7.04
| Professional | | $4.32 | $4.32 | $7.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.99 / $3.91 / $5.16
| Professional | | $2.99 | $3.91 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.76 / $8.46 / $11.42
| Professional | | $3.76 | $8.46 | $11.42 |