- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.03 / $59.64 / $352.42
| Facility | | $3.03 | $59.64 | $352.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.48 / $2.14
| Professional | | $1.47 | $1.48 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.04 / $1.04 / $1.10
| Professional | | $1.04 | $1.04 | $1.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.39 / $1.48 / $4.80
| Facility | | $1.39 | $1.48 | $4.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.48
| Professional | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.48
| Facility | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.56 / $1.85
| Professional | | $1.48 | $1.56 | $1.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.67 / $2.67 / $30.00
| Professional | | $2.67 | $2.67 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.55
| Professional | | $1.48 | $1.48 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $1.48
| Professional | | $1.47 | $1.47 | $1.48 |