- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $4.75 / $18.48
| Facility | | $3.47 | $4.75 | $18.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $3.61 / $19.68
| Professional | | $3.50 | $3.61 | $19.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $4.22 / $6.94
| Facility | | $3.37 | $4.22 | $6.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.87
| Professional | | $3.57 | $3.57 | $3.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.51 / $7.70 / $9.03
| Professional | | $3.51 | $7.70 | $9.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.57 / $5.11 / $51.41
| Facility | | $3.57 | $5.11 | $51.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.79 / $4.63
| Professional | | $3.57 | $3.79 | $4.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $4.11 / $10.41
| Facility | | $3.47 | $4.11 | $10.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.57 / $5.11 / $9.11
| Facility | | $3.57 | $5.11 | $9.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.88 / $54.06
| Professional | | $3.57 | $3.88 | $54.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.68 / $77.68 / $77.68
| Facility | | $77.68 | $77.68 | $77.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |