- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.67 / $3.08 / $3.67
| Facility | | $1.67 | $3.08 | $3.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.56 / $1.69 / $3.43
| Professional | | $1.56 | $1.69 | $3.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $2.67 / $6.24
| Facility | | $1.58 | $2.67 | $6.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $1.67 / $3.41
| Professional | | $1.54 | $1.67 | $3.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.92 / $2.14 / $3.43
| Facility | | $1.92 | $2.14 | $3.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $4.26
| Professional | | $1.70 | $1.70 | $4.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $1.58 / $1.67
| Facility | | $1.58 | $1.58 | $1.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $1.67 / $1.67
| Professional | | $1.67 | $1.67 | $1.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $2.00 / $3.84
| Professional | | $1.50 | $2.00 | $3.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $1.67 / $2.29
| Facility | | $1.58 | $1.67 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $1.67 / $3.61
| Professional | | $1.67 | $1.67 | $3.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $2.31 / $2.31
| Professional | | $2.31 | $2.31 | $2.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.34 / $1.51 / $1.84
| Professional | | $1.34 | $1.51 | $1.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.67 / $1.67 / $1.67
| Facility | | $1.67 | $1.67 | $1.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $1.67 / $3.43
| Professional | | $1.67 | $1.67 | $3.43 |