- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $4.51 / $25.68
| Facility | | $3.47 | $4.51 | $25.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $4.68
| Professional | | $3.57 | $3.57 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $3.57 / $47.10
| Professional | | $3.47 | $3.57 | $47.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.25 / $6.25 / $6.56
| Facility | | $6.25 | $6.25 | $6.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.25 / $6.25 / $6.25
| Professional | | $6.25 | $6.25 | $6.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $3.37 / $7.98
| Facility | | $3.37 | $3.37 | $7.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $5.05 / $332.00
| Facility | | $3.37 | $5.05 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.87 / $4.62
| Professional | | $3.57 | $3.87 | $4.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.71
| Facility | | $3.57 | $3.57 | $3.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.71
| Professional | | $3.57 | $3.57 | $3.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.81 / $6.84 / $20.12
| Facility | | $2.81 | $6.84 | $20.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $3.37 / $555.00
| Facility | | $3.37 | $3.37 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $21.18
| Professional | | $3.57 | $3.57 | $21.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $5.59
| Professional | | $3.57 | $3.57 | $5.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $3.71 / $3.71
| Facility | | $3.71 | $3.71 | $3.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.71 / $40.79
| Professional | | $3.57 | $3.71 | $40.79 |