- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.60 / $2.67 / $3.73
| Facility | | $1.60 | $2.67 | $3.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.11 / $2.31
| Professional | | $1.68 | $2.11 | $2.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.02 / $2.02 / $3.89
| Facility | | $2.02 | $2.02 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.02 / $2.02
| Professional | | $2.02 | $2.02 | $2.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.97 / $1.97 / $80.00
| Facility | | $1.97 | $1.97 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.99 / $2.11 / $2.11
| Facility | | $1.99 | $2.11 | $2.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.11
| Professional | | $2.11 | $2.11 | $2.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.09 / $411.09 / $411.09
| Professional | | $411.09 | $411.09 | $411.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.59 / $2.13 / $28.21
| Facility | | $1.59 | $2.13 | $28.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.15 / $3.48
| Professional | | $2.11 | $2.15 | $3.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.99 / $2.37 / $3.70
| Professional | | $1.99 | $2.37 | $3.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.89 / $2.11 / $27.86
| Facility | | $1.89 | $2.11 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $2.11 / $2.11
| Professional | | $1.96 | $2.11 | $2.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.24 / $2.38
| Professional | | $2.11 | $2.24 | $2.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.59 / $2.11 / $2.95
| Professional | | $1.59 | $2.11 | $2.95 |