- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $0.89 / $1.27
| Professional | | $0.76 | $0.89 | $1.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $0.76 / $1.48
| Professional | | $0.76 | $0.76 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.76 / $2.68 / $3.83
| Facility | | $0.76 | $2.68 | $3.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $1.15 / $1.41
| Professional | | $0.76 | $1.15 | $1.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.76 / $0.89 / $2.82
| Facility | | $0.76 | $0.89 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $1.60 / $1.60
| Professional | | $1.60 | $1.60 | $1.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.78 / $95.00 / $95.00
| Facility | | $0.78 | $95.00 | $95.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $0.89 / $1.15
| Professional | | $0.76 | $0.89 | $1.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $58.40 / $85.00
| Professional | | $50.00 | $58.40 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.76 / $0.89 / $2.82
| Facility | | $0.76 | $0.89 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $1.60 / $1.60
| Professional | | $1.60 | $1.60 | $1.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $65.00 / $95.00
| Facility | | $65.00 | $65.00 | $95.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $0.76 / $0.76
| Professional | | $0.76 | $0.76 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $2.49 / $3.87
| Professional | | $2.12 | $2.49 | $3.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.36 / $0.45 / $0.84
| Facility | | $0.36 | $0.45 | $0.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $0.89 / $1.12
| Professional | | $0.76 | $0.89 | $1.12 |