- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.23 / $1.50 / $2.46
| Facility | | $1.23 | $1.50 | $2.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $1.66
| Professional | | $1.25 | $1.25 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.25
| Facility | | $1.00 | $1.00 | $1.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.22 / $1.25 / $1.90
| Professional | | $1.22 | $1.25 | $1.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.12 / $1.12 / $1.19
| Facility | | $1.12 | $1.12 | $1.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.12 / $1.12
| Professional | | $1.12 | $1.12 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.17 / $1.17 / $1.24
| Facility | | $1.17 | $1.17 | $1.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.24 / $1.24 / $1.24
| Professional | | $1.24 | $1.24 | $1.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.17 / $1.76 / $332.00
| Facility | | $1.17 | $1.76 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.29 / $1.29 / $1.76
| Professional | | $1.29 | $1.29 | $1.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $1.27
| Facility | | $1.25 | $1.25 | $1.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $1.27
| Professional | | $1.25 | $1.25 | $1.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $1.71
| Facility | | $1.71 | $1.71 | $1.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.17 / $1.17 / $555.00
| Facility | | $1.17 | $1.17 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.24 / $1.74
| Professional | | $1.20 | $1.24 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $1.88
| Professional | | $1.25 | $1.25 | $1.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.27 / $1.27 / $1.27
| Facility | | $1.27 | $1.27 | $1.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.96 / $1.25 / $1.27
| Professional | | $0.96 | $1.25 | $1.27 |