- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.87 / $1.87 / $5,601.41
| Facility | | $1.87 | $1.87 | $5,601.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.87 / $1.87 / $1.87
| Professional | | $1.87 | $1.87 | $1.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.80 / $2.22 / $2.33
| Facility | | $1.80 | $2.22 | $2.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $1.61 / $1.61
| Professional | | $1.61 | $1.61 | $1.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.35 / $3.13 / $4.50
| Facility | | $2.35 | $3.13 | $4.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $1.61 / $1.61
| Professional | | $1.53 | $1.61 | $1.61 |