- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $3.40 / $62.79
| Facility | | $1.57 | $3.40 | $62.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.59 / $4.29
| Professional | | $1.57 | $1.59 | $4.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.76 / $2.25
| Facility | | $1.48 | $1.76 | $2.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.64 / $6.68
| Professional | | $1.57 | $1.64 | $6.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.18 / $2.29 / $3.69
| Facility | | $2.18 | $2.29 | $3.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $1.60 / $4.55
| Professional | | $1.60 | $1.60 | $4.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.57
| Facility | | $1.48 | $1.48 | $1.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $1.57
| Professional | | $1.57 | $1.57 | $1.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.88 / $4.00
| Professional | | $1.41 | $1.88 | $4.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.57 / $2.27
| Facility | | $1.48 | $1.57 | $2.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $3.40
| Professional | | $1.57 | $1.57 | $3.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.46 / $3.46 / $3.46
| Professional | | $3.46 | $3.46 | $3.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $4.22
| Professional | | $1.57 | $1.57 | $4.22 |