- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.97 / $175.56 / $325.68
| Facility | | $17.97 | $175.56 | $325.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $14.13 / $17.71
| Professional | | $13.45 | $14.13 | $17.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.07 / $11.07 / $11.07
| Facility | | $11.07 | $11.07 | $11.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $19.82 / $31.90
| Professional | | $12.25 | $19.82 | $31.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.03 / $45.30 / $82.45
| Facility | | $17.03 | $45.30 | $82.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $16.50 / $16.50
| Professional | | $16.50 | $16.50 | $16.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.15 / $10.45 / $25.55
| Professional | | $7.15 | $10.45 | $25.55 |