- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.85 / $3.70 / $4.16
| Facility | | $1.85 | $3.70 | $4.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.87 / $3.18
| Professional | | $1.85 | $1.87 | $3.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.85 / $2.96 / $6.56
| Facility | | $1.85 | $2.96 | $6.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $5.21
| Professional | | $1.85 | $1.85 | $5.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.02 / $2.25 / $4.21
| Facility | | $2.02 | $2.25 | $4.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $1.89 / $5.31
| Professional | | $1.89 | $1.89 | $5.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $1.85
| Facility | | $1.75 | $1.75 | $1.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $1.85
| Professional | | $1.85 | $1.85 | $1.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $2.22 / $4.26
| Professional | | $1.67 | $2.22 | $4.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $85.00 / $85.00
| Facility | | $75.00 | $85.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $1.85 / $2.65
| Facility | | $1.75 | $1.85 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $4.00
| Professional | | $1.85 | $1.85 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.17 / $3.17 / $3.17
| Professional | | $3.17 | $3.17 | $3.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.67 / $2.04
| Professional | | $1.48 | $1.67 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.60 / $5.90 / $5.90
| Facility | | $5.60 | $5.90 | $5.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $3.94
| Professional | | $1.85 | $1.85 | $3.94 |