- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.04 / $6.04 / $361.62
| Facility | | $6.04 | $6.04 | $361.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.33 / $3.30 / $13.12
| Professional | | $1.33 | $3.30 | $13.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $2.31 / $2.31
| Professional | | $2.31 | $2.31 | $2.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.61 / $9.47 / $11.11
| Professional | | $7.61 | $9.47 | $11.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.34 / $4.18 / $7.65
| Facility | | $3.34 | $4.18 | $7.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.42 / $4.32 / $4.78
| Professional | | $3.42 | $4.32 | $4.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.60 / $4.44 / $5.23
| Facility | | $3.60 | $4.44 | $5.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.87 / $4.55 / $4.78
| Professional | | $3.87 | $4.55 | $4.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.34 / $4.33 / $7.65
| Facility | | $3.34 | $4.33 | $7.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $3.98 / $4.86
| Professional | | $2.31 | $3.98 | $4.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.76 / $5.01 / $5.01
| Professional | | $4.76 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $1.93 / $3.68
| Professional | | $1.74 | $1.93 | $3.68 |