- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $7.08 / $13.80
| Facility | | $1.00 | $7.08 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.41 / $38.02
| Professional | | $1.00 | $1.41 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $1.41
| Professional | | $1.41 | $1.41 | $1.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.66 / $3.31
| Facility | | $1.48 | $1.66 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.51 / $5.62
| Professional | | $1.41 | $1.51 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $3.31 / $3.31
| Facility | | $3.31 | $3.31 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $2.04 / $4.27
| Professional | | $1.32 | $2.04 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.32 / $1.32 / $1.41
| Facility | | $1.32 | $1.32 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $2.19
| Professional | | $1.41 | $1.41 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $1.55
| Professional | | $1.41 | $1.41 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.62 / $3.02
| Professional | | $1.26 | $1.62 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $7.41
| Professional | | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $2.04 / $3.72
| Facility | | $1.41 | $2.04 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $1.38 / $2.19
| Professional | | $1.38 | $1.38 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $3.39 / $3.39
| Professional | | $3.39 | $3.39 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.51 / $2.40
| Professional | | $1.12 | $1.51 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.79 / $4.79 / $4.79
| Facility | | $4.79 | $4.79 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $3.80
| Professional | | $1.41 | $1.41 | $3.80 |