- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.02 / $8.02 / $34.95
| Facility | | $2.02 | $8.02 | $34.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.29 / $4.42
| Professional | | $2.02 | $2.29 | $4.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.69 / $1.76 / $26.92
| Professional | | $1.69 | $1.76 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.30 / $10.60 / $10.60
| Facility | | $5.30 | $10.60 | $10.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $1.52 / $1.65
| Professional | | $1.52 | $1.52 | $1.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.73 / $2.70 / $6.23
| Facility | | $1.73 | $2.70 | $6.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $1.83 / $3.61
| Professional | | $1.66 | $1.83 | $3.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.02 / $2.29 / $5.00
| Facility | | $2.02 | $2.29 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.42 / $3.64 / $5.00
| Professional | | $3.42 | $3.64 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.78 / $3.46
| Professional | | $1.27 | $1.78 | $3.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.00 / $60.00 / $100.00
| Facility | | $20.00 | $60.00 | $100.00 |