- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $3.80 / $3.80
| Facility | | $3.80 | $3.80 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $3.80
| Professional | | $1.00 | $1.00 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $1.95 / $79.43
| Facility | | $1.58 | $1.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $1.45 / $1.95
| Professional | | $0.79 | $1.45 | $1.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.23 / $1.23 / $3.72
| Facility | | $1.23 | $1.23 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.35 / $1.35
| Professional | | $1.20 | $1.35 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.72 / $1.35 / $1.35
| Facility | | $0.72 | $1.35 | $1.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.12 / $1.41
| Professional | | $1.12 | $1.12 | $1.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $1.66 / $2.51
| Professional | | $1.66 | $1.66 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.43 / $0.43 / $0.43
| Professional | | $0.43 | $0.43 | $0.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $1.95 / $79.43
| Facility | | $1.58 | $1.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $1.48 / $2.14
| Professional | | $0.79 | $1.48 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.23 / $1.23 / $1.29
| Professional | | $1.23 | $1.23 | $1.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.72 / $0.89 / $1.20
| Facility | | $0.72 | $0.89 | $1.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $1.12 / $1.66
| Professional | | $0.79 | $1.12 | $1.66 |