- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.32 / $6.51 / $10.68
| Facility | | $5.32 | $6.51 | $10.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $7.21
| Professional | | $5.32 | $5.32 | $7.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $4.26 / $5.32
| Facility | | $4.26 | $4.26 | $5.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.93 / $5.32 / $5.32
| Professional | | $4.93 | $5.32 | $5.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.61 / $4.61 / $4.84
| Facility | | $4.61 | $4.61 | $4.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.61 / $4.61 / $4.61
| Professional | | $4.61 | $4.61 | $4.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.87 / $5.01 / $5.32
| Facility | | $4.87 | $5.01 | $5.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $5.32
| Professional | | $5.32 | $5.32 | $5.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $7.53 / $332.00
| Facility | | $5.01 | $7.53 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $5.77 / $7.05
| Professional | | $5.77 | $5.77 | $7.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $5.52
| Facility | | $5.32 | $5.32 | $5.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $5.52
| Professional | | $5.32 | $5.32 | $5.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.87 / $5.01 / $555.00
| Facility | | $4.87 | $5.01 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $7.16
| Professional | | $5.32 | $5.32 | $7.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $7.18
| Professional | | $5.32 | $5.32 | $7.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.52 / $5.52 / $5.52
| Facility | | $5.52 | $5.52 | $5.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $5.52
| Professional | | $5.32 | $5.32 | $5.52 |