- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.11
| Facility | | $0.05 | $0.05 | $0.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.07
| Professional | | $0.05 | $0.05 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.30
| Professional | | $0.05 | $0.05 | $0.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $3.57 / $5.11
| Facility | | $0.05 | $3.57 | $5.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $1.55 / $1.88
| Professional | | $0.05 | $1.55 | $1.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $0.05 / $0.06
| Facility | | $0.04 | $0.05 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $2.14 / $2.14
| Professional | | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $0.05 / $100.00
| Facility | | $0.04 | $0.05 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.05
| Professional | | $0.02 | $0.02 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.22 / $58.40 / $85.00
| Professional | | $0.22 | $58.40 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $0.05 / $0.06
| Facility | | $0.04 | $0.05 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $2.14 / $2.14
| Professional | | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.00 / $70.00 / $100.00
| Facility | | $70.00 | $70.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.05
| Professional | | $0.05 | $0.05 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $12.12 / $18.85
| Professional | | $10.30 | $12.12 | $18.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.04
| Professional | | $0.02 | $0.02 | $0.04 |