- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $37.04 / $37.04
| Facility | | $0.03 | $37.04 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $37.04 / $37.04
| Professional | | $37.04 | $37.04 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $5.81 / $12.29
| Professional | | $5.81 | $5.81 | $12.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.46 / $30.76 / $36.54
| Facility | | $30.46 | $30.76 | $36.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $63.16 / $63.16
| Facility | | $0.56 | $63.16 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $27.26 / $44.90
| Professional | | $11.24 | $27.26 | $44.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.40 / $24.40 / $24.86
| Facility | | $24.40 | $24.40 | $24.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.75 / $24.40 / $24.40
| Professional | | $20.75 | $24.40 | $24.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $12.83 / $24.29
| Professional | | $11.24 | $12.83 | $24.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $135.76 / $135.76
| Facility | | $50.00 | $135.76 | $135.76 |