- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.23 / $6.46 / $12.93
| Facility | | $3.23 | $6.46 | $12.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.23 / $5.17 / $27.71
| Professional | | $3.23 | $5.17 | $27.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.75 / $28.54 / $46.34
| Facility | | $7.75 | $28.54 | $46.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $3.53 / $4.05
| Professional | | $2.65 | $3.53 | $4.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.80 / $2.80 / $2.80
| Facility | | $2.80 | $2.80 | $2.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $4.96 / $7.89
| Professional | | $2.65 | $4.96 | $7.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $2.37
| Professional | | $2.37 | $2.37 | $2.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.83 / $5.17 / $8.41
| Facility | | $3.83 | $5.17 | $8.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $4.30 / $7.89
| Professional | | $4.30 | $4.30 | $7.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $2.56 / $2.64
| Professional | | $1.81 | $2.56 | $2.64 |