- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $10.64 / $24.30
| Facility | | $10.64 | $10.64 | $24.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.08 / $8.16 / $52.08
| Professional | | $6.08 | $8.16 | $52.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.58 / $53.46 / $87.12
| Facility | | $14.58 | $53.46 | $87.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.97 / $6.63 / $7.61
| Professional | | $4.97 | $6.63 | $7.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.27 / $5.27 / $5.27
| Facility | | $5.27 | $5.27 | $5.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.36 / $9.50 / $13.32
| Professional | | $4.36 | $9.50 | $13.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.46 / $4.46 / $4.46
| Professional | | $4.46 | $4.46 | $4.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.22 / $9.72 / $13.68
| Facility | | $6.22 | $9.72 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.43 / $8.10 / $13.32
| Professional | | $7.43 | $8.10 | $13.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.40 / $4.13 / $4.86
| Professional | | $3.40 | $4.13 | $4.86 |