- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.34 / $8.55 / $30.74
| Facility | | $3.34 | $8.55 | $30.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $5.60 / $7.01
| Professional | | $5.60 | $5.60 | $7.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $5.60 / $7.52
| Professional | | $5.60 | $5.60 | $7.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.35 / $5.35 / $5.62
| Facility | | $5.35 | $5.35 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.35 / $5.35 / $5.35
| Professional | | $5.35 | $5.35 | $5.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.17 / $5.28 / $5.60
| Facility | | $5.17 | $5.28 | $5.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $5.60 / $5.60
| Professional | | $5.60 | $5.60 | $5.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.28 / $11.88 / $332.00
| Facility | | $5.28 | $11.88 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.08 / $6.08 / $13.86
| Professional | | $6.08 | $6.08 | $13.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.60 / $5.60 / $5.81
| Facility | | $5.60 | $5.60 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $5.60 / $5.81
| Professional | | $5.60 | $5.60 | $5.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.62 / $4.96 / $15.46
| Facility | | $1.62 | $4.96 | $15.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.17 / $5.28 / $555.00
| Facility | | $5.17 | $5.28 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $5.60 / $11.21
| Professional | | $5.13 | $5.60 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $5.60 / $10.43
| Professional | | $5.60 | $5.60 | $10.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.81 / $5.81 / $5.81
| Facility | | $5.81 | $5.81 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.04 / $5.60 / $5.81
| Professional | | $4.04 | $5.60 | $5.81 |