- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.59 / $2.11 / $3.50
| Facility | | $1.59 | $2.11 | $3.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.84 / $2.11 / $2.20
| Professional | | $1.84 | $2.11 | $2.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.34 / $2.11 / $2.54
| Professional | | $1.34 | $2.11 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.46 / $1.46 / $1.53
| Facility | | $1.46 | $1.46 | $1.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.46 / $1.46 / $1.46
| Professional | | $1.46 | $1.46 | $1.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.80 / $1.99 / $85.00
| Facility | | $1.80 | $1.99 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.49
| Professional | | $2.11 | $2.11 | $2.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $3.28 / $332.00
| Facility | | $2.29 | $3.28 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.29 / $2.57
| Professional | | $2.11 | $2.29 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.15
| Facility | | $2.11 | $2.11 | $2.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.15 / $2.15
| Professional | | $2.11 | $2.15 | $2.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.80 / $1.99 / $85.00
| Facility | | $1.80 | $1.99 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.11 / $2.49
| Professional | | $2.06 | $2.11 | $2.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.22 / $2.83
| Professional | | $2.02 | $2.22 | $2.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.15 / $2.15 / $2.15
| Facility | | $2.15 | $2.15 | $2.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.15 / $2.15
| Professional | | $2.11 | $2.15 | $2.15 |