- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.19 / $1.31 / $12.80
| Facility | | $1.19 | $1.31 | $12.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.31 / $1.86 / $12.80
| Professional | | $1.31 | $1.86 | $12.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.83 / $3.83 / $3.83
| Professional | | $3.83 | $3.83 | $3.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.53 / $1.85 / $4.88
| Facility | | $1.53 | $1.85 | $4.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $2.18 / $4.13
| Professional | | $2.13 | $2.18 | $4.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.69 / $6.09 / $9.41
| Facility | | $4.69 | $6.09 | $9.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $9.52 / $16.71
| Professional | | $2.40 | $9.52 | $16.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.67 / $2.67 / $3.95
| Facility | | $2.67 | $2.67 | $3.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $3.30
| Professional | | $2.27 | $2.27 | $3.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $4.44 / $5.33
| Professional | | $3.55 | $4.44 | $5.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $3.11 / $6.88
| Professional | | $2.66 | $3.11 | $6.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $80.00 / $80.00
| Facility | | $75.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.98 / $21.98 / $32.10
| Professional | | $21.98 | $21.98 | $32.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.22 / $3.93 / $4.51
| Facility | | $1.22 | $3.93 | $4.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.67 / $4.17
| Professional | | $2.27 | $2.67 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $8.36 / $8.36
| Professional | | $8.36 | $8.36 | $8.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $5.20 / $6.76
| Professional | | $3.55 | $5.20 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.69 / $1.88 / $4.29
| Professional | | $1.69 | $1.88 | $4.29 |