- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $3.43 / $7.84
| Professional | | $2.58 | $3.43 | $7.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.11 / $80.00 / $85.00
| Facility | | $6.11 | $80.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.66 / $5.12 / $7.86
| Professional | | $0.66 | $5.12 | $7.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.20 / $4.20 / $5.51
| Facility | | $4.20 | $4.20 | $5.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $4.20 / $5.51
| Professional | | $3.57 | $4.20 | $5.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.30 / $6.30 / $6.30
| Facility | | $6.30 | $6.30 | $6.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $6.30 / $6.30
| Professional | | $6.30 | $6.30 | $6.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.43 / $6.04 / $7.27
| Professional | | $5.43 | $6.04 | $7.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.30 / $6.86 / $7.78
| Facility | | $6.30 | $6.86 | $7.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $6.86 / $7.78
| Professional | | $6.30 | $6.86 | $7.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.57 / $0.57 / $8.55
| Facility | | $0.57 | $0.57 | $8.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.52 / $5.19 / $6.55
| Professional | | $0.52 | $5.19 | $6.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.11 / $6.11 / $6.11
| Facility | | $6.11 | $6.11 | $6.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.54 / $0.54 / $0.66
| Professional | | $0.54 | $0.54 | $0.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.05 / $3.59 / $5.86
| Professional | | $3.05 | $3.59 | $5.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.12 / $5.12 / $5.62
| Professional | | $5.12 | $5.12 | $5.62 |