- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $18.28 / $26.94
| Facility | | $10.30 | $18.28 | $26.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.25 / $8.58 / $70.73
| Professional | | $8.25 | $8.58 | $70.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.90 / $11.00 / $13.75
| Facility | | $4.90 | $11.00 | $13.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $6.45 / $8.07
| Professional | | $4.40 | $6.45 | $8.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.15 / $12.87 / $39.83
| Facility | | $7.15 | $12.87 | $39.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $12.80 / $16.00
| Professional | | $6.30 | $12.80 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.12 / $11.00 / $11.55
| Professional | | $0.12 | $11.00 | $11.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.91 / $2.91 / $2.91
| Professional | | $2.91 | $2.91 | $2.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.62 / $4.97 / $11.00
| Professional | | $4.62 | $4.97 | $11.00 |