- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.52 / $164.37 / $552.25
| Facility | | $1.52 | $164.37 | $552.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.48 / $1.63
| Professional | | $1.47 | $1.48 | $1.63 |
- 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
- $2.46 / $3.04 / $3.50
| Facility | | $2.46 | $3.04 | $3.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.64 / $1.64 / $1.67
| Professional | | $1.64 | $1.64 | $1.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.64 / $31.64 / $31.64
| Facility | | $31.64 | $31.64 | $31.64 |
- 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 / $1.48
| Professional | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $2.93
| Professional | | $1.48 | $1.48 | $2.93 |