- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $5.13 / $6.76
| Facility | | $3.72 | $5.13 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $5.50
| Professional | | $2.00 | $2.00 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.51 / $3.09 / $7.59
| Facility | | $2.51 | $3.09 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $2.51 / $6.03
| Professional | | $2.45 | $2.51 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $3.24 / $5.37
| Facility | | $2.75 | $3.24 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $3.24 / $7.41
| Professional | | $2.45 | $3.24 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $2.34 / $2.45
| Facility | | $2.34 | $2.34 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $2.45 / $2.45
| Professional | | $2.45 | $2.45 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $2.69 / $5.62
| Professional | | $2.24 | $2.69 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $100.00
| Facility | | $85.11 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.34 / $2.34
| Professional | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.45 / $3.72 / $6.17
| Facility | | $2.45 | $3.72 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $2.45 / $3.47
| Professional | | $2.45 | $2.45 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $3.89
| Professional | | $3.89 | $3.89 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $2.24 / $2.69
| Professional | | $1.95 | $2.24 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.45 / $7.08 / $7.08
| Facility | | $2.45 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $2.45 / $6.03
| Professional | | $2.45 | $2.45 | $6.03 |