- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $3.30 / $68.19
| Facility | | $2.06 | $3.30 | $68.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.06 / $3.48
| Professional | | $2.06 | $2.06 | $3.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.46 / $3.39 / $25.70
| Facility | | $2.46 | $3.39 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.02 / $1.02 / $2.94
| Professional | | $1.02 | $1.02 | $2.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.17 / $3.48 / $5.41
| Facility | | $3.17 | $3.48 | $5.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.46 / $3.85
| Professional | | $2.56 | $3.46 | $3.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $3.08
| Professional | | $2.54 | $2.54 | $3.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $3.30 / $68.19
| Facility | | $2.54 | $3.30 | $68.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.54 / $2.96
| Professional | | $2.06 | $2.54 | $2.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $2.08 / $5.01
| Professional | | $1.52 | $2.08 | $5.01 |