- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.19 / $0.45 / $63.18
| Facility | | $0.19 | $0.45 | $63.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.23
| Professional | | $0.19 | $0.19 | $0.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.18 / $0.19 / $0.97
| Facility | | $0.18 | $0.19 | $0.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.25
| Facility | | $0.19 | $0.19 | $0.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.20 / $0.20
| Professional | | $0.10 | $0.20 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.36 / $40.00 / $40.00
| Professional | | $0.36 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.20 / $0.20
| Professional | | $0.19 | $0.20 | $0.20 |