- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.52 / $10.88 / $618.36
| Facility | | $2.52 | $10.88 | $618.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.52 / $3.70
| Professional | | $2.52 | $2.52 | $3.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $9.89 / $32.40
| Facility | | $3.72 | $9.89 | $32.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.36 / $0.41 / $0.49
| Professional | | $0.36 | $0.41 | $0.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.62 / $2.62 / $2.62
| Facility | | $2.62 | $2.62 | $2.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $2.62 / $2.62
| Professional | | $2.62 | $2.62 | $2.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.40 / $2.78 / $8.39
| Facility | | $1.40 | $2.78 | $8.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.68 / $4.70 / $5.90
| Professional | | $3.68 | $4.70 | $5.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $12.67
| Facility | | $12.67 | $12.67 | $12.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $2.57
| Professional | | $2.57 | $2.57 | $2.57 |