- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.25 / $3.75 / $10.60
| Facility | | $2.25 | $3.75 | $10.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $3.05
| Professional | | $2.25 | $2.25 | $3.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $7.19
| Professional | | $2.25 | $2.25 | $7.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.14 / $3.14 / $3.30
| Facility | | $3.14 | $3.14 | $3.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $3.14 / $3.14
| Professional | | $3.14 | $3.14 | $3.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $2.13 / $3.36
| Facility | | $2.13 | $2.13 | $3.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $2.25
| Professional | | $2.25 | $2.25 | $2.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $7.02 / $332.00
| Facility | | $2.13 | $7.02 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $2.46 / $5.92
| Professional | | $2.46 | $2.46 | $5.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $2.35
| Facility | | $2.25 | $2.25 | $2.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $2.35
| Professional | | $2.25 | $2.25 | $2.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $3.71 / $3.71
| Facility | | $3.71 | $3.71 | $3.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $2.13 / $555.00
| Facility | | $2.13 | $2.13 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.39 / $6.04
| Professional | | $2.25 | $2.39 | $6.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $4.07
| Professional | | $2.25 | $2.25 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.35 / $2.35 / $2.35
| Facility | | $2.35 | $2.35 | $2.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.35 / $6.37
| Professional | | $2.25 | $2.35 | $6.37 |