- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.61 / $2.38 / $4.03
| Facility | | $1.61 | $2.38 | $4.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.49 / $2.72
| Professional | | $1.47 | $1.49 | $2.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.62 / $85.00 / $85.00
| Facility | | $1.62 | $85.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $153.90
| Professional | | $1.47 | $1.47 | $153.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.38 / $1.38 / $1.38
| Facility | | $1.38 | $1.38 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $1.78
| Professional | | $1.47 | $1.47 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.47 / $1.75 / $5.36
| Facility | | $1.47 | $1.75 | $5.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.75 / $3.82
| Professional | | $1.47 | $1.75 | $3.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $1.55 / $70.00
| Professional | | $1.38 | $1.55 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $1.66 / $3.04
| Facility | | $1.41 | $1.66 | $3.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.62 / $1.62 / $1.62
| Facility | | $1.62 | $1.62 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $1.84 / $2.36
| Professional | | $1.32 | $1.84 | $2.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.08 / $1.47 / $2.15
| Facility | | $1.08 | $1.47 | $2.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.40 / $1.47 / $1.53
| Professional | | $1.40 | $1.47 | $1.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $1.47
| Professional | | $1.47 | $1.47 | $1.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.22 / $1.22 / $1.22
| Professional | | $1.22 | $1.22 | $1.22 |