- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $2.82 / $131.83
| Facility | | $1.58 | $2.82 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $3.63
| Professional | | $1.00 | $1.00 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $1.35
| Professional | | $1.35 | $1.35 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $4.47 / $11.22
| Facility | | $3.31 | $4.47 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.48 / $1.48
| Professional | | $1.35 | $1.48 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $1.35
| Facility | | $1.35 | $1.35 | $1.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $2.40
| Professional | | $1.35 | $1.35 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $2.14 / $2.51
| Facility | | $1.41 | $2.14 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.91 / $2.57 / $2.88
| Facility | | $1.91 | $2.57 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $2.34
| Professional | | $1.35 | $1.35 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $104.71 / $104.71
| Facility | | $100.00 | $104.71 | $104.71 |