- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.69 / $76.42 / $261.69
| Facility | | $8.69 | $76.42 | $261.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.59 / $0.59 / $0.65
| Professional | | $0.59 | $0.59 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.55 / $0.59 / $0.59
| Facility | | $0.55 | $0.59 | $0.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.59 / $0.59 / $0.59
| Professional | | $0.59 | $0.59 | $0.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.59 / $0.59 / $5.66
| Facility | | $0.59 | $0.59 | $5.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.59 / $0.62 / $0.62
| Professional | | $0.59 | $0.62 | $0.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.63 / $0.63 / $0.93
| Facility | | $0.63 | $0.63 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.59 / $0.59 / $1.03
| Professional | | $0.59 | $0.59 | $1.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $0.59
| Professional | | $0.56 | $0.56 | $0.59 |