- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.51 / $1.51 / $1.51
| Facility | | $1.51 | $1.51 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $2.00
| Professional | | $1.00 | $1.00 | $2.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $1.95 / $1.95
| Professional | | $1.95 | $1.95 | $1.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.17 / $1.17 / $1.45
| Facility | | $1.17 | $1.17 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.38
| Professional | | $1.00 | $1.00 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $2.63 / $3.80
| Professional | | $1.86 | $2.63 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $2.00
| Facility | | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.41 / $2.00
| Professional | | $1.20 | $1.41 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.48
| Professional | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.51 / $1.51 / $1.51
| Facility | | $1.51 | $1.51 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $2.00
| Professional | | $1.00 | $1.00 | $2.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.24 / $3.24 / $3.24
| Facility | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $2.82 / $3.89
| Professional | | $0.60 | $2.82 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $2.14
| Facility | | $1.41 | $1.41 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.86 / $2.14
| Professional | | $1.41 | $1.86 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.68 / $0.89 / $1.26
| Facility | | $0.68 | $0.89 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.66 / $0.98 / $2.00
| Professional | | $0.66 | $0.98 | $2.00 |