- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.36 / $2.75 / $5.36
| Facility | | $1.36 | $2.75 | $5.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.43 / $2.54 / $2.67
| Professional | | $1.43 | $2.54 | $2.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $1.88 / $1.88
| Professional | | $1.88 | $1.88 | $1.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.79 / $1.79 / $8.92
| Facility | | $1.79 | $1.79 | $8.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.79 / $1.79 / $1.79
| Professional | | $1.79 | $1.79 | $1.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $3.33 / $4.91
| Professional | | $1.68 | $3.33 | $4.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $80.00
| Facility | | $1.25 | $1.25 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $2.54 / $2.54
| Facility | | $2.40 | $2.54 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.54
| Professional | | $2.54 | $2.54 | $2.54 |
- 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
- $853.09 / $853.09 / $853.09
| Professional | | $853.09 | $853.09 | $853.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.34 / $2.54 / $7.29
| Facility | | $1.34 | $2.54 | $7.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $4.19
| Professional | | $2.54 | $2.54 | $4.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.31 / $2.59 / $5.60
| Professional | | $1.31 | $2.59 | $5.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.33 / $2.54 / $7.29
| Facility | | $2.33 | $2.54 | $7.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.54 / $2.54
| Professional | | $2.02 | $2.54 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.69 / $8.01
| Professional | | $2.54 | $2.69 | $8.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.34 / $2.54 / $3.56
| Professional | | $1.34 | $2.54 | $3.56 |