- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.61 / $13.61 / $34.03
| Facility | | $13.61 | $13.61 | $34.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $11.02 / $13.61
| Professional | | $11.02 | $11.02 | $13.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.17 / $18.17 / $115.89
| Facility | | $13.17 | $18.17 | $115.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $5.44 / $13.24
| Professional | | $5.44 | $5.44 | $13.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.27 / $16.79 / $29.04
| Facility | | $14.27 | $16.79 | $29.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.75 / $15.69 / $19.62
| Professional | | $13.75 | $15.69 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.61 / $13.61 / $16.48
| Professional | | $13.61 | $13.61 | $16.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.61 / $13.61 / $34.03
| Facility | | $13.61 | $13.61 | $34.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $11.02 / $13.61
| Professional | | $11.02 | $11.02 | $13.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $9.36 / $22.62
| Professional | | $8.17 | $9.36 | $22.62 |