- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.70 / $2.06 / $3.40
| Facility | | $1.70 | $2.06 | $3.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $2.29
| Professional | | $1.70 | $1.70 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.36 / $1.36 / $1.70
| Facility | | $1.36 | $1.36 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.62 / $1.70 / $2.29
| Professional | | $1.62 | $1.70 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.53 / $1.53 / $1.61
| Facility | | $1.53 | $1.53 | $1.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $1.53 / $1.53
| Professional | | $1.53 | $1.53 | $1.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.60 / $1.70
| Facility | | $1.57 | $1.60 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $1.70
| Professional | | $1.70 | $1.70 | $1.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.60 / $2.40 / $332.00
| Facility | | $1.60 | $2.40 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.76 / $1.76 / $2.19
| Professional | | $1.76 | $1.76 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $1.76
| Facility | | $1.70 | $1.70 | $1.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $1.76
| Professional | | $1.70 | $1.70 | $1.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.60 / $555.00
| Facility | | $1.57 | $1.60 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.18 / $1.70 / $2.33
| Professional | | $1.18 | $1.70 | $2.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $2.38
| Professional | | $1.70 | $1.70 | $2.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.76 / $1.76 / $1.76
| Facility | | $1.76 | $1.76 | $1.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.92 / $1.70 / $1.76
| Professional | | $0.92 | $1.70 | $1.76 |