- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $3.02 / $3.02
| Facility | | $2.34 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $3.02 / $3.98
| Professional | | $1.95 | $3.02 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.45 / $2.45 / $2.95
| Facility | | $2.45 | $2.45 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $2.24 / $2.24
| Professional | | $2.24 | $2.24 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $3.80 / $4.79
| Professional | | $2.82 | $3.80 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.79 / $4.79 / $79.43
| Facility | | $4.79 | $4.79 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $2.95
| Facility | | $2.82 | $2.82 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.82
| Professional | | $2.40 | $2.40 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $35.48 / $35.48
| Professional | | $23.44 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.51 / $3.98 / $6.61
| Facility | | $2.51 | $3.98 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.02 / $4.79
| Professional | | $2.00 | $3.02 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.63 / $2.63 / $81.28
| Professional | | $2.63 | $2.63 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $3.80 / $6.92
| Facility | | $2.34 | $3.80 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $3.16
| Professional | | $2.40 | $2.40 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.29 / $1.82 / $2.19
| Facility | | $1.29 | $1.82 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $2.14 / $2.82
| Professional | | $1.66 | $2.14 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $4.79 / $4.79
| Professional | | $4.79 | $4.79 | $4.79 |