- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.72 / $1.00 / $8.40
| Facility | | $0.72 | $1.00 | $8.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $2.94
| Professional | | $1.00 | $1.00 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $8.00 / $8.00
| Professional | | $8.00 | $8.00 | $8.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.48 / $19.44 / $40.50
| Facility | | $12.48 | $19.44 | $40.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.67 / $7.00 / $10.00
| Professional | | $0.67 | $7.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.66 / $20.09 / $30.43
| Facility | | $13.66 | $20.09 | $30.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $10.81 / $10.81
| Professional | | $10.81 | $10.81 | $10.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $15.00 / $100.00
| Professional | | $10.00 | $15.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $100.00 / $100.00
| Facility | | $65.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Professional | | $85.00 | $85.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1.43 / $2.94
| Facility | | $1.00 | $1.43 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $10.81 / $10.81
| Professional | | $10.81 | $10.81 | $10.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.92 / $31.92 / $31.92
| Professional | | $31.92 | $31.92 | $31.92 |