- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $130.10 / $566.77
| Facility | | $1.48 | $130.10 | $566.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.63
| Professional | | $1.48 | $1.48 | $1.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $1.54 / $1.92
| Professional | | $1.54 | $1.54 | $1.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.48 / $4.03 / $27.38
| Facility | | $2.48 | $4.03 | $27.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $1.62
| Professional | | $1.47 | $1.47 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.77 / $1.93 / $2.24
| Facility | | $1.77 | $1.93 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.69 / $1.95 / $4.05
| Professional | | $1.69 | $1.95 | $4.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $1.61 / $1.61
| Professional | | $1.61 | $1.61 | $1.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.63
| Professional | | $1.48 | $1.48 | $1.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $1.47
| Professional | | $1.47 | $1.47 | $1.47 |