- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $2.57 / $607.55
| Facility | | $2.54 | $2.57 | $607.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.65
| Professional | | $2.54 | $2.54 | $2.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.19 / $8.17 / $16.23
| Facility | | $3.19 | $8.17 | $16.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.35 / $3.35 / $3.35
| Professional | | $3.35 | $3.35 | $3.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.56 / $2.94 / $896.40
| Facility | | $2.56 | $2.94 | $896.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $80.00 / $80.00
| Facility | | $2.54 | $80.00 | $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
- $11.23 / $11.23 / $11.23
| Professional | | $11.23 | $11.23 | $11.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $2.56 / $5.38
| Facility | | $2.54 | $2.56 | $5.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $3.18
| Professional | | $2.54 | $2.54 | $3.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $3.54 / $5.72
| Professional | | $2.75 | $3.54 | $5.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $5.37
| Facility | | $2.54 | $2.54 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $3.07
| Professional | | $2.54 | $2.54 | $3.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.56
| Professional | | $2.54 | $2.54 | $2.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $3.43
| Professional | | $2.54 | $2.54 | $3.43 |