- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.50 / $13.49 / $112.20
| Facility | | $5.50 | $13.49 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.08 / $10.72
| Professional | | $6.03 | $7.08 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $12.02 / $14.79
| Facility | | $9.33 | $12.02 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $10.72 / $12.02
| Professional | | $5.75 | $10.72 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $19.05 / $26.92
| Facility | | $7.41 | $19.05 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $58.88 / $58.88
| Professional | | $5.13 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $97.72 / $144.54
| Facility | | $28.18 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $5.37 / $5.37
| Professional | | $5.37 | $5.37 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $5.37 / $5.37
| Facility | | $5.37 | $5.37 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $5.25 / $12.02
| Professional | | $3.72 | $5.25 | $12.02 |