- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $3.01 / $4.51
| Facility | | $3.01 | $3.01 | $4.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $3.01 / $3.20
| Professional | | $2.59 | $3.01 | $3.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.32
| Professional | | $3.13 | $3.13 | $3.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.44
| Facility | | $3.13 | $3.13 | $3.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $3.13
| Professional | | $3.13 | $3.13 | $3.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $3.39 / $3.84
| Facility | | $3.20 | $3.39 | $3.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.20 / $3.20
| Professional | | $3.20 | $3.20 | $3.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.13 / $4.70 / $332.00
| Facility | | $3.13 | $4.70 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.20 / $4.29
| Professional | | $3.20 | $3.20 | $4.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $3.32 / $3.32
| Facility | | $3.20 | $3.32 | $3.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.32 / $3.32
| Professional | | $3.20 | $3.32 | $3.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $3.39 / $597.00
| Facility | | $3.20 | $3.39 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.20 / $4.78
| Professional | | $3.20 | $3.20 | $4.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $3.13 / $4.62
| Professional | | $2.82 | $3.13 | $4.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $3.20 / $3.20
| Facility | | $3.20 | $3.20 | $3.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.20 / $3.32
| Professional | | $3.20 | $3.20 | $3.32 |