- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $7.76 / $7.76
| Facility | | $7.08 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.94 / $11.22
| Professional | | $7.08 | $7.94 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $8.13 / $8.13
| Professional | | $2.40 | $8.13 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.90 / $8.32 / $13.18
| Facility | | $4.90 | $8.32 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $4.37 / $5.75
| Professional | | $3.72 | $4.37 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $3.63 / $7.76
| Facility | | $2.29 | $3.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.07 / $5.37
| Professional | | $1.07 | $1.07 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $3.63 / $7.76
| Facility | | $2.29 | $3.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $8.13 / $10.47
| Professional | | $8.13 | $8.13 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $85.11
| Professional | | $64.57 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $5.50 / $7.76
| Professional | | $3.72 | $5.50 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $100.00
| Facility | | $8.32 | $8.32 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $8.32
| Professional | | $8.32 | $8.32 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $4.07 / $7.59
| Professional | | $4.07 | $4.07 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $9.77
| Facility | | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $8.13 / $11.22
| Professional | | $8.13 | $8.13 | $11.22 |