- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.15 / $2.59 / $98.00
| Facility | | $1.15 | $2.59 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.15 / $1.15 / $1.45
| Professional | | $1.15 | $1.15 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $2.75 / $9.60
| Professional | | $1.21 | $2.75 | $9.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.99 / $1.79 / $2.54
| Facility | | $0.99 | $1.79 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.77 / $5.01 / $5.69
| Professional | | $0.77 | $5.01 | $5.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.15 / $1.45 / $6.41
| Facility | | $1.15 | $1.45 | $6.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.87 / $1.87 / $1.87
| Professional | | $1.87 | $1.87 | $1.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.15 / $1.45 / $6.41
| Facility | | $1.15 | $1.45 | $6.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $1.21 / $1.87
| Professional | | $1.21 | $1.21 | $1.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $55.00 / $85.00
| Professional | | $3.01 | $55.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.15 / $1.45 / $6.41
| Facility | | $1.15 | $1.45 | $6.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.87 / $1.87 / $1.87
| Professional | | $1.87 | $1.87 | $1.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $6.86 / $9.90
| Professional | | $3.24 | $6.86 | $9.90 |
- 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
- $1.23 / $1.23 / $1.23
| Professional | | $1.23 | $1.23 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $5.40 / $9.86
| Professional | | $5.40 | $5.40 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $1.21 / $1.82
| Professional | | $1.21 | $1.21 | $1.82 |