- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.42 / $57.78 / $236.55
| Facility | | $3.42 | $57.78 | $236.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.48
| Professional | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $3.96
| Professional | | $1.47 | $1.47 | $3.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.39 / $1.39 / $1.48
| Facility | | $1.39 | $1.39 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.88
| Professional | | $1.48 | $1.48 | $1.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.26 / $2.12
| Professional | | $1.26 | $1.26 | $2.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $2.40
| Professional | | $1.48 | $1.48 | $2.40 |