- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $61.94 / $297.46
| Facility | | $2.06 | $61.94 | $297.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.49 / $5.31
| Professional | | $1.47 | $1.49 | $5.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.67 / $2.22 / $4.58
| Facility | | $1.67 | $2.22 | $4.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.81
| Professional | | $1.48 | $1.48 | $1.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.39 / $1.48 / $1.48
| Facility | | $1.39 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.60
| Professional | | $1.48 | $1.48 | $1.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.97
| Professional | | $1.48 | $1.48 | $1.97 |