- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $51.29 / $223.87
| Facility | | $9.33 | $51.29 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.08 / $0.11 / $0.12
| Facility | | $0.08 | $0.11 | $0.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.04 / $0.06 / $0.12
| Professional | | $0.04 | $0.06 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.12 / $0.12 / $0.12
| Facility | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.12 / $0.12 / $0.14
| Professional | | $0.12 | $0.12 | $0.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.04 / $0.05
| Facility | | $0.02 | $0.04 | $0.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.07 / $0.07 / $0.09
| Facility | | $0.07 | $0.07 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.04 / $0.12 / $0.12
| Professional | | $0.04 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |